[Bayesian analysis of myocardial scintigraphy using 99mTc-Sn(II)-methylenediphosphonate and using...

Myocardial scintigraphy with 99mTc-Sn (II)-Methylenediphosphonate (MDP) and with 99mTc-Sn (II) pyrophosphate (PPi) was performed in 185 patients with proven acute myocardial infarction (90 with MDP; 95 with PPi), and in 65 subjects with acute chest pain of a different etiology (37 with MDP; 28 with PPi), during the first five days after the onset of illness. Sensitivity, specificity and accuracy of the procedure were higher with PPi (0.895, 0.893, 0.894) than with MDP (0.822, 0.865, 0.835) in the diagnosis of AMI. Based on the usual clinical electrocardiographic and biochemical criteria, the likelihood of AMI on the population studied with MDP was of 70.9% and with PPi of 77.2%. Application of Bayes' theorem showed an increase in the likelihood of AMI, when myocardial scintigraphy was positive, from 70.9% to 93.7% when MDP was used, and from 77.2% to 96.6 when PPi was the tracer, with incremental ruling in gaings of 22.8% and 19.4%) respectively. A normal scintigraphy, on the other hand, reduced the likelihood of AMI from 70.9% to 33.4% when MDP was used, and from 77.2% to 29.2% when PPi was the tracer, with respective incremental ruling-out gains of 37.5% and 48.0%. Although homogeinity between the populations studied with each tracer was not proven, existing practical, clinical and biochemical evidence allows the conclusion that PPi is a better agent than MDP in the study of patients with acute chest pain.