Patient management after noninvasive cardiac imaging results from SPARC (Study of myocardial perfusion and coronary anatomy imaging roles in coronary artery disease).

MedStar author(s):
Citation: Journal of the American College of Cardiology. 59(5):462-74, 2012 Jan 31.PMID: 22281249Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Comparative Study | Journal ArticleSubject headings: *Cardiac Catheterization/mt [Methods] | *Cardiovascular Agents/tu [Therapeutic Use] | *Coronary Artery Disease/di [Diagnosis] | *Myocardial Perfusion Imaging/mt [Methods] | Aged | Coronary Angiography/mt [Methods] | Coronary Artery Disease/th [Therapy] | Diagnosis, Differential | Female | Follow-Up Studies | Humans | Male | Middle Aged | Positron-Emission Tomography/mt [Methods] | Prognosis | Prospective Studies | Severity of Illness Index | Time Factors | Tomography, Emission-Computed, Single-Photon/mt [Methods] | Tomography, X-Ray Computed/mt [Methods]Year: 2012Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:
  • 0735-1097
Name of journal: Journal of the American College of CardiologyAbstract: BACKGROUND: Noninvasive cardiac imaging is widely used in coronary artery disease, but its effects on subsequent patient management are unclear.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). Copyright 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.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.OBJECTIVES: This study examined short-term cardiac catheterization rates and medication changes after cardiac imaging.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.All authors: Abbara S, Arrighi J, Beanlands RS, Berman DS, Bokhari S, Borges-Neto S, Branscomb E, Brunken R, Budoff M, Caldwell J, Chareonthaitawee P, Chow BJ, Corbett J, Corn CR, Delbeke D, Di Carli MF, Dorbala S, Farkas S, Foster C, Gaber M, Guarneri E, Hachamovitch R, Hainer J, Heller GV, Hlatky MA, Hoffmann U, Jacobs JE, Johnson B, Johnson JR, Kazerooni E, Lesser J, Lima J, Machac J, Millstine JW, Nutter B, Patterson R, Rabinowitz S, Raman S, Reichek N, Ridner ML, Schoepf UJ, Schussheim A, Shaw LJ, Sigman SR, SPARC Investigators, Thomson LE, Voros S, Weigold WG, White R, Williams JA, Williams KA, Yasuda TFiscal year: FY2013Digital Object Identifier: Date added to catalog: 2013-09-17
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 22281249 Available 22281249

Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007

BACKGROUND: Noninvasive cardiac imaging is widely used in coronary artery disease, but its effects on subsequent patient management are unclear.

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). Copyright 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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.

OBJECTIVES: This study examined short-term cardiac catheterization rates and medication changes after cardiac imaging.

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.

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