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Failure of Gated Single Photon Emission Computer Tomography Scan to Detect Imminent Acute Plaque Rupture Causing Acute ST-Elevation Myocardial Infarction*: Case Report

Mohammad-Reza Movahed, MD, PhD, FACC, FACP
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*From the University of California, Irvine Medical Center, Orange, CA.

Correspondence to: Mohammad-Reza Movahed, MD, PhD, Assistant Clinical Professor, Director, Nucler Cardiology, University of California, Irvine Medical Center, 101 The City Dr, Bldg 53, Rm 100, Orange, CA 92868-4080; e-mail: mmovahed@uci.edu



Chest. 2005;128(2):1043-1047. doi:10.1378/chest.128.2.1043
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The negative predictive value of a gated single photon emission computer tomography (SPECT) scan is very high, with an event rate of < 1% in the first year. However, the presence of nonobstructive coronary artery plaque should yield normal SPECT scan findings. On the other hand, most plaque ruptures, which are a major cause of acute myocardial infarction, occur in nonobstructive coronary artery plaque. Therefore, the findings of a gated SPECT scan should be normal if a ruptured plaque has not created significant obstruction despite the imminent threat of coronary artery occlusion. We present the first case report of a documented gated SPECT scan in a patient who had experienced an acute anterior Q-wave myocardial infarction showing no significant ischemia in the anterior wall in the last minute of data acquisition.

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