Clinical role of bone scintigraphy in low-to-intermediate Framingham risk patients with atypical chest pain

Abstract

Objective: The purpose of the study is to evaluate the clinical usefulness of bone scintigraphy for etiological diagnosis of patients with atypical chest pain.

Patients and methods: We retrospectively enrolled 225 patients with atypical chest pain who underwent bone scintigraphy for etiological diagnosis. No patients showed any symptoms or signs other than chest pain and had low-to-intermediate Framingham risk with insignificant findings on initial cardiac evaluation. They had no recent traumatic events or history of cerebrovascular and coronary heart diseases. The usefulness of bone scintigraphy for clinical diagnosis in enrolled patients was assessed and compared according to age (<60 vs. ≥60 years).

Results: Sixty-two (27.6%) patients were at intermediate Framingham risk and 100 (44.5%) patients were older than or equal to 60 years of age. Bone scintigraphy showed abnormal findings in 111 (49.4%) patients. Clinical diagnoses of chest pain were made in 163 (72.4%) patients. The remaining 62 (27.6%) patients were assessed as having unknown etiology. Bone scintigraphy was helpful for clinical diagnosis in 94 (41.8%) patients. Patients older than or equal to 60 years of age had significantly more frequent abnormal findings and post-traumatic changes on bone scintigraphy than patients younger than 60 years of age (P=0.010 for all). Of 111 patients with abnormal findings on bone scintigraphy, six (5.4%) were diagnosed with coronary heart disease; all of them were older than or equal to 60 years.

Conclusion: Bone scintigraphy was helpful for etiological diagnosis of atypical chest pain in 41.8% of patients. However, coronary heart disease should be considered in patients older than or equal to 60 years of age, even if patients showed abnormal findings on bone scintigraphy.