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Background The acute benefits of platelet glycoprotein IIb/IIIa inhibitors for non-ST–segment elevation acute coronary syndromes (NSTE ACS) remain unclear. Methods In this pilot trial, 311 patients with NSTE ACS were randomly assigned in the emergency department to double-blinded therapy with eptifibatide or placebo for 12 to 24 hours before crossover to open-label eptifibatide. Serial creatine-kinase MB (CK-MB) and quantitative cardiac troponin T levels were collected during the first 24 hours to assess the impact of early platelet glycoprotein IIb/IIIa blockade on infarct size as measured by cardiac markers. Results Median peak CK-MB (10.3 vs 11.8 ng/mL; P = .71) and peak quantitative cardiac troponin T levels (0.2 vs 0.3 ng/mL; P = .95) were similar between treatment groups, respectively. Median calculated peak CK-MB values (41 vs 40 ng/mL; P = .72) and area under the CK-MB curve measurements (980 vs 764 μg/min/L; P = .68) from curve-fitting analyses that could be performed in 106 of 311 patients were also similar. Conclusions In this pilot trial, early administration of eptifibatide in the emergency department did not modulate serologic measurements of infarct size in patients with NSTE ACS.

ACC/AHA guidelines assign a class I indication for use of myocardial perfusion imaging (MPI) for the evaluation of chest pain in patients with acute coronary syndromes and a nondiagnostic ECG. However, MPI is not a widely used modality for the evaluation of patients who present to the ER with chest pain and an intermediate pretest probability for coronary artery disease. We report a case in which resting MPI was pivotal in diagnosing acute myocardial infarction and expedited the appropriate reperfusion strategy. Copyright © 2010 Wiley Periodicals, Inc.

Acute SPECT imaging with Tc-99m sestamibi is an emerging, cost-effective stratagem for selected patients arriving at the emergency department with chest pain. To date, the cohort of patients studied have included those who arrive at the emergency department with typical chest pain and a normal or nondiagnostic electrocardiogram. This application could be extended to other clinical settings. The current case demonstrates that in an outpatient setting, a severe rest SPECT perfusion defect in a symptomatic patient with a nondiagnostic electrocardiogram prompted timely hospitalization and revascularization. The resting defect was consistent with jeopardized, viable myocardium as it normalized after revascularization.