The Coronary Artery Disease-Reporting and Data System (CAD-RADS): Prognostic and Clinical Implications Associated With Standardized Coronary Computed Tomography Angiography Reporting

Journal article


Publication Details

Author(s): Xie JX, Cury RC, Leipsic J, Crim MT, Berman DS, Gransar H, Budoff MJ, Achenbach S, Hartaigh BO, Callister TQ, Marques H, Rubinshtein R, Al-Mallah MH, Andreini D, Pontone G, Cademartiri F, Maffei E, Chinnaiyan K, Raff G, Hadamitzky M, Hausleiter J, Feuchtner G, Dunning A, Delago A, Kim YJ, Kaufmann PA, Villines TC, Chow BJW, Hindoyan N, Gomez M, Lin FY, Jones E, Min JK, Shaw LJ
Journal: Journal of the American College of Cardiology : Cardiovascular imaging
Publication year: 2018
Volume: 11
Journal issue: 1
Pages range: 78-89
ISSN: 1936-878X
eISSN: 1876-7591


Abstract

OBJECTIVES: This study sought to assess clinical outcomes associated with the novel Coronary Artery Disease-Reporting and Data System (CAD-RADS) scores used to standardize coronary computed tomography angiography (CTA) reporting and their potential utility in guiding post-coronary CTA care.
BACKGROUND: Clinical decision support is a major focus of health care policies aimed at improving guideline-directed care. Recently, CAD-RADS was developed to standardize coronary CTA reporting and includes clinical recommendations to facilitate patient management after coronary CTA.
METHODS: In the multinational CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry, 5,039 patients without known coronary artery disease (CAD) underwent coronary CTA and were stratified by CAD-RADS scores, which rank CAD stenosis severity as 0 (0%), 1 (1% to 24%), 2 (25% to 49%), 3 (50% to 69%), 4A (70% to 99% in 1 to 2 vessels), 4B (70% to 99% in 3 vessels or ≥50% left main), or 5 (100%). Kaplan-Meier and multivariable Cox models were used to estimate all-cause mortality or myocardial infarction (MI). Receiver-operating characteristic (ROC) curves were used to compare CAD-RADS to the Duke CAD Index and traditional CAD classification. Referrals to invasive coronary angiography (ICA) after coronary CTA were also assessed.
RESULTS: Cumulative 5-year event-free survival ranged from 95.2% to 69.3% for CAD-RADS 0 to 5 (p < 0.0001). Higher scores were associated with elevations in event risk (hazard ratio: 2.46 to 6.09; p < 0.0001). The ROC curve for prediction of death or MI was 0.7052 for CAD-RADS, which was noninferior to the Duke Index (0.7073; p = 0.893) and traditional CAD classification (0.7095; p = 0.783). ICA rates were 13% for CAD-RADS 0 to 2, 66% for CAD-RADS 3, and 84% for CAD-RADS ≥4A. For CAD-RADS 3, 58% of all catheterizations occurred within the first 30 days of follow-up. In a patient subset with available medication data, 57% of CAD-RADS 3 patients who received 30-day ICA were either asymptomatic or not receiving antianginal therapy at baseline, whereas only 32% had angina and were receiving medical therapy.
CONCLUSIONS: CAD-RADS effectively identified patients at risk for adverse events. Frequent ICA use was observed among patients without severe CAD, many of whom were asymptomatic or not taking antianginal drugs. Incorporating CAD-RADS into coronary CTA reports may provide a novel opportunity to promote evidence-based care post-coronary CTA.


FAU Authors / FAU Editors

Achenbach, Stephan Prof. Dr. med.
Medizinische Klinik 2 - Kardiologie, Angiologie


External institutions with authors

Baptist Health South Florida
Beaumont Health System
Capitol Cardiology Associates
Cedars-Sinai Medical Center
Cornell University
Deutsches Herzzentrum München
Duke University Medical Center
Emory University
Harbor–UCLA Medical Center
Henry Ford Health System (HFHS)
Hospital da Luz
Ludwig-Maximilians-Universität (LMU)
Medizinische Universität Innsbruck
Seoul National University (SNU) / 서울대학교
Technion - Israel Institute of Technology
Tennessee Heart & Vascular
Università degli studi di Milano
Universitätsspital Zürich (USZ)
Université de Montréal
University of British Columbia
University of Ottawa
Walter Reed Army Medical Center (WRAMC)


How to cite

APA:
Xie, J.X., Cury, R.C., Leipsic, J., Crim, M.T., Berman, D.S., Gransar, H.,... Shaw, L.J. (2018). The Coronary Artery Disease-Reporting and Data System (CAD-RADS): Prognostic and Clinical Implications Associated With Standardized Coronary Computed Tomography Angiography Reporting. Journal of the American College of Cardiology : Cardiovascular imaging, 11(1), 78-89. https://dx.doi.org/10.1016/j.jcmg.2017.08.026

MLA:
Xie, Joe X., et al. "The Coronary Artery Disease-Reporting and Data System (CAD-RADS): Prognostic and Clinical Implications Associated With Standardized Coronary Computed Tomography Angiography Reporting." Journal of the American College of Cardiology : Cardiovascular imaging 11.1 (2018): 78-89.

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Last updated on 2018-01-11 at 21:08