TY - JOUR
T1 - Patient management after noninvasive cardiac imaging
T2 - Results from SPARC (Study of myocardial perfusion and coronary anatomy imaging roles in coronary artery disease)
AU - Hachamovitch, Rory
AU - Nutter, Benjamin
AU - Hlatky, Mark A.
AU - Shaw, Leslee J.
AU - Ridner, Michael L.
AU - Dorbala, Sharmila
AU - Beanlands, Rob S.B.
AU - Chow, Benjamin J.W.
AU - Branscomb, Elizabeth
AU - Chareonthaitawee, Panithaya
AU - Weigold, W. Guy
AU - Voros, Szilard
AU - Abbara, Suhny
AU - Yasuda, Tsunehiro
AU - Jacobs, Jill E.
AU - Lesser, John
AU - Berman, Daniel S.
AU - Thomson, Louise E.J.
AU - Raman, Subha
AU - Heller, Gary V.
AU - Schussheim, Adam
AU - Brunken, Richard
AU - Williams, Kim A.
AU - Farkas, Susan
AU - Delbeke, Dominique
AU - Schoepf, Uwe J.
AU - Reichek, Nathaniel
AU - Rabinowitz, Stuart
AU - Sigman, Steven R.
AU - Patterson, Randall
AU - Corn, Carolyn R.
AU - White, Richard
AU - Kazerooni, Ella
AU - Corbett, James
AU - Bokhari, Sabahat
AU - MacHac, Josef
AU - Guarneri, Erminia
AU - Borges-Neto, Salvador
AU - Millstine, John W.
AU - Caldwell, James
AU - Arrighi, James
AU - Hoffmann, Udo
AU - Budoff, Matthew
AU - Lima, Joao
AU - Johnson, James R.
AU - Johnson, Barbara
AU - Gaber, Mariya
AU - Williams, Julie A.
AU - Foster, Courtney
AU - Hainer, Jon
AU - Di Carli, Marcelo F.
N1 - Funding Information:
SPARC is an investigator-initiated study funded in part by a grant from the NHLBI ( HL101060-01 ) and by unrestricted research grants from Bracco Diagnostics Inc. ; Astellas Pharma US, Inc. ; GE Healthcare ; and Siemens Medical Solutions ; and unrestricted equipment support for the central imaging analysis from Vital Images. The companies providing unrestricted grants had no access to study data nor had control over any aspect of the study design, data collection, or data analysis. Dr. Hachamovitch has received unrestricted grants from Astellas , Siemens , and Bracco . Dr. Shaw has received grant support from Bracco and Astellas . Dr. Dorbala has received support from Astellas Pharma US Inc. Dr. Beanlands has received research grants from LMI , GE , and Nordion ; and is a consultant for LMI and DraxImage. Dr. Chow has received research support from GE Healthcare, Pfizer, and AstraZeneca; eduational support from TeraRecon; and fellowship support from GE Healthcare. Dr. Branscomb is a consultant for Bracco. Dr. Chareonthaitawee has received a research grant from Astellas Pharma Inc. Dr. Voros has received a research grant from Abbott Vascular , Volcano , Abbott Pharma , Toshiba America Medical Systems , Vital Images , CardioDx , Merck , and Cardiogenesis ; is a consultant for HDL Inc. and Marquis Imaging; and is on the advisory board and Speaker's Bureau for Merck and Abbott Laboratories. Dr. Abbara has received a research grant from Bracco and BD Medical ; and is a consultant for Perceptive Informatics. Dr. Raman has received research support from Siemens. Dr. Heller has received support from Bracco Diagnostics, GE Healthcare, Astellas, and Lantheus. Dr. Williams is on the advisory board and Speaker's Bureau for Astellas Healthcare. Dr. Schoepf is a consultant for and received research support from Bayer, Bracco, GE, Medrad, and Siemens. Dr. Borges-Neto has received grant support and is on the Speaker's Bureau for GE Health , Astellas , and Gilead . Dr. Caldwell has received research support from Forest Laboratories and GE Medical; and is a consultant for Lantheus Imaging. Dr. Arrighi is on the Speaker's Bureau of Astellas Pharma. Dr. Di Carli has received an unrestricted research grant from Astellas , Bracco , Siemens , and GE Healthcare ; support from Vital Images; and research grant support from Toshiba Medical Imaging . All other author have reported that they have no relationships relevant to the contents of this paper to disclose. David Cohen, MD, served as Guest Editor for this paper.
PY - 2012/1/31
Y1 - 2012/1/31
N2 - Objectives: This study examined short-term cardiac catheterization rates and medication changes after cardiac imaging. Background: Noninvasive cardiac imaging is widely used in coronary artery disease, but its effects on subsequent patient management are unclear. Methods: We assessed the 90-day post-test rates of catheterization and medication changes in a prospective registry of 1,703 patients without a documented history of coronary artery disease and an intermediate to high likelihood of coronary artery disease undergoing cardiac single-photon emission computed tomography, positron emission tomography, or 64-slice coronary computed tomography angiography. Results: Baseline medication use was relatively infrequent. At 90 days, 9.6% of patients underwent catheterization. The rates of catheterization and medication changes increased in proportion to test abnormality findings. Among patients with the most severe test result findings, 38% to 61% were not referred to catheterization, 20% to 30% were not receiving aspirin, 35% to 44% were not receiving a beta-blocker, and 20% to 25% were not receiving a lipid-lowering agent at 90 days after the index test. Risk-adjusted analyses revealed that compared with stress single-photon emission computed tomography or positron emission tomography, changes in aspirin and lipid-lowering agent use was greater after computed tomography angiography, as was the 90-day catheterization referral rate in the setting of normal/nonobstructive and mildly abnormal test results. Conclusions: Overall, noninvasive testing had only a modest impact on clinical management of patients referred for clinical testing. Although post-imaging use of cardiac catheterization and medical therapy increased in proportion to the degree of abnormality findings, the frequency of catheterization and medication change suggests possible undertreatment of higher risk patients. Patients were more likely to undergo cardiac catheterization after computed tomography angiography than after single-photon emission computed tomography or positron emission tomography after normal/nonobstructive and mildly abnormal study findings. (Study of Perfusion and Anatomy's Role in Coronary Artery [CAD] [SPARC]; NCT00321399)
AB - Objectives: This study examined short-term cardiac catheterization rates and medication changes after cardiac imaging. Background: Noninvasive cardiac imaging is widely used in coronary artery disease, but its effects on subsequent patient management are unclear. Methods: We assessed the 90-day post-test rates of catheterization and medication changes in a prospective registry of 1,703 patients without a documented history of coronary artery disease and an intermediate to high likelihood of coronary artery disease undergoing cardiac single-photon emission computed tomography, positron emission tomography, or 64-slice coronary computed tomography angiography. Results: Baseline medication use was relatively infrequent. At 90 days, 9.6% of patients underwent catheterization. The rates of catheterization and medication changes increased in proportion to test abnormality findings. Among patients with the most severe test result findings, 38% to 61% were not referred to catheterization, 20% to 30% were not receiving aspirin, 35% to 44% were not receiving a beta-blocker, and 20% to 25% were not receiving a lipid-lowering agent at 90 days after the index test. Risk-adjusted analyses revealed that compared with stress single-photon emission computed tomography or positron emission tomography, changes in aspirin and lipid-lowering agent use was greater after computed tomography angiography, as was the 90-day catheterization referral rate in the setting of normal/nonobstructive and mildly abnormal test results. Conclusions: Overall, noninvasive testing had only a modest impact on clinical management of patients referred for clinical testing. Although post-imaging use of cardiac catheterization and medical therapy increased in proportion to the degree of abnormality findings, the frequency of catheterization and medication change suggests possible undertreatment of higher risk patients. Patients were more likely to undergo cardiac catheterization after computed tomography angiography than after single-photon emission computed tomography or positron emission tomography after normal/nonobstructive and mildly abnormal study findings. (Study of Perfusion and Anatomy's Role in Coronary Artery [CAD] [SPARC]; NCT00321399)
KW - cardiac
KW - imaging
KW - noninvasive
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U2 - 10.1016/j.jacc.2011.09.066
DO - 10.1016/j.jacc.2011.09.066
M3 - Article
C2 - 22281249
AN - SCOPUS:84862908116
SN - 0735-1097
VL - 59
SP - 462
EP - 474
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 5
ER -