000			05001nam a22005777a 4500
008			130913s20122012 xxu||||| |||| 00| 0 eng dOvid Technologies
022			_a0735-1097
040			_aOvid MEDLINE(R)
099			_a22281249
245			_aPatient management after noninvasive cardiac imaging results from SPARC (Study of myocardial perfusion and coronary anatomy imaging roles in coronary artery disease).
251			_aJournal of the American College of Cardiology. 59(5):462-74, 2012 Jan 31.
252			_aJ Am Coll Cardiol. 59(5):462-74, 2012 Jan 31.
253			_aJournal of the American College of Cardiology
260			_c2012
260			_fFY2013
266			_d2013-09-17
501			_aAvailable online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
520			_aBACKGROUND: Noninvasive cardiac imaging is widely used in coronary artery disease, but its effects on subsequent patient management are unclear.
520			_aCONCLUSIONS: 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.
520			_aMETHODS: 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.
520			_aOBJECTIVES: This study examined short-term cardiac catheterization rates and medication changes after cardiac imaging.
520			_aRESULTS: 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.
546			_aEnglish
650			_a*Cardiac Catheterization/mt [Methods]
650			_a*Cardiovascular Agents/tu [Therapeutic Use]
650			_a*Coronary Artery Disease/di [Diagnosis]
650			_a*Myocardial Perfusion Imaging/mt [Methods]
650			_aAged
650			_aCoronary Angiography/mt [Methods]
650			_aCoronary Artery Disease/th [Therapy]
650			_aDiagnosis, Differential
650			_aFemale
650			_aFollow-Up Studies
650			_aHumans
650			_aMale
650			_aMiddle Aged
650			_aPositron-Emission Tomography/mt [Methods]
650			_aPrognosis
650			_aProspective Studies
650			_aSeverity of Illness Index
650			_aTime Factors
650			_aTomography, Emission-Computed, Single-Photon/mt [Methods]
650			_aTomography, X-Ray Computed/mt [Methods]
651			_aMedStar Heart & Vascular Institute
657			_aComparative Study
657			_aJournal Article
700			_aWeigold, William Guy
790			_aAbbara 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 T
856			_uhttp://dx.doi.org/10.1016/j.jacc.2011.09.066 _zhttp://dx.doi.org/10.1016/j.jacc.2011.09.066
942			_cART _dArticle
999			_c1401 _d1401