The study of myocardial perfusion and coronary  anatomy imaging roles in CAD (SPARC): design,  rationale, and baseline patient characteristics of  a prospective, multicenter observational registry  comparing PET, SPECT, and CTA for resource  utilization and clinical outcomes.
OBJECTIVE
To design a multicenter study comparing the prognostic value and post-test resource utilization of PET, CT Coronary Angiography (CTA), and SPECT in clinical practice.


BACKGROUND
Although PET, CTA, and SPECT are widely used, their relative clinical- and cost-effectiveness are undefined.


METHODS
The Study of Myocardial Perfusion and Coronary Anatomy Imaging Roles in CAD (SPARC) is a prospective, multicenter, observational registry that has enrolled 3019 patients undergoing clinically referred SPECT, PET, and CTA with the goal of comparing posttest resource utilization and comparative prognostic value. Resource utilization assessment will enroll intermediate-high likelihood patients without prior CAD, while prognostic assessment will include both these patients and patients with prior CAD. Secondary analyses include assessments of diagnostic accuracy, cost, and referral to revascularization. Sites recruited into at least two of the three imaging arms. Except for semi-quantitative interpretation, site protocols will be used for all imaging studies and images forwarded to an image repository. Follow-up for catheterization, revascularization, cardiac death, myocardial infarction, all-cause death and medication use changes will be performed at 90-day, 1, and 2 years. Standard statistical methods will be used to risk-adjust results within and between study arms. SPARC will have >85% power (two-sided test, alpha = 0.01) to detect a 5% catheterization rate difference at 90 days between the three arms and >90% power to detect a 2% difference in cardiac death, or nonfatal MI within 2 years of the index test.
Hachamovitch
Rory
R
Division of Nuclear Medicine/PET, Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA. hach@msn.com
Johnson
James R
JR
Hlatky
Mark A
MA
Cantagallo
Lisa
L
Johnson
Barbara H
BH
Coughlan
Martha
M
Hainer
Jon
J
Gierbolini
Jeselle
J
Di Carli
Marcelo F
MF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000706:statistics & numerical data*; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data*; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology