ABSTRACT: ObjectivesTo design a multicenter study comparing the prognostic value and post-test resource utilization of PET, CT Coronary Angiography
(CTA), and SPECT in clinical practice.
BackgroundAlthough PET, CTA, and SPECT are widely used, their relative clinical- and cost-effectiveness are undefined.
MethodsThe 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 post-test
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, α=0.01) to detect
a 5% catheterization rate difference at 90days between the three arms and >90% power to detect a 2% difference in cardiac
death, or nonfatal MI within 2years of the index test.
ConclusionsSPARC will be the first study comparing outcomes and resource utilization between SPECT, PET, and CTA in daily practice. In
addition, the study design offers insights into inter-site and geographic differences in referral patterns and resource utilization.
Journal of Nuclear Cardiology 04/2012; 16(6):935-948. · 2.67 Impact Factor