Patient management after noninvasive cardiac imaging

Results from SPARC (Study of myocardial perfusion and coronary anatomy imaging roles in coronary artery disease)

Rory Hachamovitch, Benjamin Nutter, Mark A. Hlatky, Leslee J. Shaw, Michael L. Ridner, Sharmila Dorbala, Rob S B Beanlands, Benjamin J W Chow, Elizabeth Branscomb, Panithaya Chareonthaitawee, W. Guy Weigold, Szilard Voros, Suhny Abbara, Tsunehiro Yasuda, Jill E. Jacobs, John Lesser, Daniel S. Berman, Louise E J Thomson, Subha Raman, Gary V. Heller & 31 others Adam Schussheim, Richard Brunken, Kim A. Williams, Susan Farkas, Dominique Delbeke, Uwe J. Schoepf, Nathaniel Reichek, Stuart Rabinowitz, Steven R. Sigman, Randall Patterson, Carolyn R. Corn, Richard White, Ella Kazerooni, James Corbett, Sabahat Bokhari, Josef MacHac, Erminia Guarneri, Salvador Borges-Neto, John W. Millstine, James Caldwell, James Arrighi, Udo Hoffmann, Matthew Budoff, Joao Lima, James R. Johnson, Barbara Johnson, Mariya Gaber, Julie A. Williams, Courtney Foster, Jon Hainer, Marcelo F. Di Carli

Research output: Contribution to journalArticle

Abstract

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)

Original languageEnglish (US)
Pages (from-to)462-474
Number of pages13
JournalJournal of the American College of Cardiology
Volume59
Issue number5
DOIs
StatePublished - Jan 31 2012

Fingerprint

Coronary Artery Disease
Anatomy
Catheterization
Perfusion
Cardiac Catheterization
Single-Photon Emission-Computed Tomography
Positron-Emission Tomography
Aspirin
Lipids
Registries
Coronary Vessels
Referral and Consultation
Computed Tomography Angiography

Keywords

  • cardiac
  • imaging
  • noninvasive

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Patient management after noninvasive cardiac imaging : Results from SPARC (Study of myocardial perfusion and coronary anatomy imaging roles in coronary artery disease). / Hachamovitch, Rory; Nutter, Benjamin; Hlatky, Mark A.; Shaw, Leslee J.; Ridner, Michael L.; Dorbala, Sharmila; Beanlands, Rob S B; Chow, Benjamin J W; Branscomb, Elizabeth; Chareonthaitawee, Panithaya; Weigold, W. Guy; Voros, Szilard; Abbara, Suhny; Yasuda, Tsunehiro; Jacobs, Jill E.; Lesser, John; Berman, Daniel S.; Thomson, Louise E J; Raman, Subha; Heller, Gary V.; Schussheim, Adam; Brunken, Richard; Williams, Kim A.; Farkas, Susan; Delbeke, Dominique; Schoepf, Uwe J.; Reichek, Nathaniel; Rabinowitz, Stuart; Sigman, Steven R.; Patterson, Randall; Corn, Carolyn R.; White, Richard; Kazerooni, Ella; Corbett, James; Bokhari, Sabahat; MacHac, Josef; Guarneri, Erminia; Borges-Neto, Salvador; Millstine, John W.; Caldwell, James; Arrighi, James; Hoffmann, Udo; Budoff, Matthew; Lima, Joao; Johnson, James R.; Johnson, Barbara; Gaber, Mariya; Williams, Julie A.; Foster, Courtney; Hainer, Jon; Di Carli, Marcelo F.

In: Journal of the American College of Cardiology, Vol. 59, No. 5, 31.01.2012, p. 462-474.

Research output: Contribution to journalArticle

Hachamovitch, R, Nutter, B, Hlatky, MA, Shaw, LJ, Ridner, ML, Dorbala, S, Beanlands, RSB, Chow, BJW, Branscomb, E, Chareonthaitawee, P, Weigold, WG, Voros, S, Abbara, S, Yasuda, T, Jacobs, JE, Lesser, J, Berman, DS, Thomson, LEJ, Raman, S, Heller, GV, Schussheim, A, Brunken, R, Williams, KA, Farkas, S, Delbeke, D, Schoepf, UJ, Reichek, N, Rabinowitz, S, Sigman, SR, Patterson, R, Corn, CR, White, R, Kazerooni, E, Corbett, J, Bokhari, S, MacHac, J, Guarneri, E, Borges-Neto, S, Millstine, JW, Caldwell, J, Arrighi, J, Hoffmann, U, Budoff, M, Lima, J, Johnson, JR, Johnson, B, Gaber, M, Williams, JA, Foster, C, Hainer, J & Di Carli, MF 2012, 'Patient management after noninvasive cardiac imaging: Results from SPARC (Study of myocardial perfusion and coronary anatomy imaging roles in coronary artery disease)', Journal of the American College of Cardiology, vol. 59, no. 5, pp. 462-474. https://doi.org/10.1016/j.jacc.2011.09.066
Hachamovitch, Rory ; Nutter, Benjamin ; Hlatky, Mark A. ; Shaw, Leslee J. ; Ridner, Michael L. ; Dorbala, Sharmila ; Beanlands, Rob S B ; Chow, Benjamin J W ; Branscomb, Elizabeth ; Chareonthaitawee, Panithaya ; Weigold, W. Guy ; Voros, Szilard ; Abbara, Suhny ; Yasuda, Tsunehiro ; Jacobs, Jill E. ; Lesser, John ; Berman, Daniel S. ; Thomson, Louise E J ; Raman, Subha ; Heller, Gary V. ; Schussheim, Adam ; Brunken, Richard ; Williams, Kim A. ; Farkas, Susan ; Delbeke, Dominique ; Schoepf, Uwe J. ; Reichek, Nathaniel ; Rabinowitz, Stuart ; Sigman, Steven R. ; Patterson, Randall ; Corn, Carolyn R. ; White, Richard ; Kazerooni, Ella ; Corbett, James ; Bokhari, Sabahat ; MacHac, Josef ; Guarneri, Erminia ; Borges-Neto, Salvador ; Millstine, John W. ; Caldwell, James ; Arrighi, James ; Hoffmann, Udo ; Budoff, Matthew ; Lima, Joao ; Johnson, James R. ; Johnson, Barbara ; Gaber, Mariya ; Williams, Julie A. ; Foster, Courtney ; Hainer, Jon ; Di Carli, Marcelo F. / Patient management after noninvasive cardiac imaging : Results from SPARC (Study of myocardial perfusion and coronary anatomy imaging roles in coronary artery disease). In: Journal of the American College of Cardiology. 2012 ; Vol. 59, No. 5. pp. 462-474.
@article{a493aee968414269a7b11b8c8bf13196,
title = "Patient management after noninvasive cardiac imaging: Results from SPARC (Study of myocardial perfusion and coronary anatomy imaging roles in coronary artery disease)",
abstract = "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)",
keywords = "cardiac, imaging, noninvasive",
author = "Rory Hachamovitch and Benjamin Nutter and Hlatky, {Mark A.} and Shaw, {Leslee J.} and Ridner, {Michael L.} and Sharmila Dorbala and Beanlands, {Rob S B} and Chow, {Benjamin J W} and Elizabeth Branscomb and Panithaya Chareonthaitawee and Weigold, {W. Guy} and Szilard Voros and Suhny Abbara and Tsunehiro Yasuda and Jacobs, {Jill E.} and John Lesser and Berman, {Daniel S.} and Thomson, {Louise E J} and Subha Raman and Heller, {Gary V.} and Adam Schussheim and Richard Brunken and Williams, {Kim A.} and Susan Farkas and Dominique Delbeke and Schoepf, {Uwe J.} and Nathaniel Reichek and Stuart Rabinowitz and Sigman, {Steven R.} and Randall Patterson and Corn, {Carolyn R.} and Richard White and Ella Kazerooni and James Corbett and Sabahat Bokhari and Josef MacHac and Erminia Guarneri and Salvador Borges-Neto and Millstine, {John W.} and James Caldwell and James Arrighi and Udo Hoffmann and Matthew Budoff and Joao Lima and Johnson, {James R.} and Barbara Johnson and Mariya Gaber and Williams, {Julie A.} and Courtney Foster and Jon Hainer and {Di Carli}, {Marcelo F.}",
year = "2012",
month = "1",
day = "31",
doi = "10.1016/j.jacc.2011.09.066",
language = "English (US)",
volume = "59",
pages = "462--474",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "5",

}

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.

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

UR - http://www.scopus.com/inward/record.url?scp=84862908116&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84862908116&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2011.09.066

DO - 10.1016/j.jacc.2011.09.066

M3 - Article

VL - 59

SP - 462

EP - 474

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 5

ER -