Prognostic Value of Coronary CTA in Stable Chest Pain: CAD-RADS, CAC, and Cardiovascular Events in PROMISE

Bittner DO, Mayrhofer T, Budoff M, Szilveszter B, Foldyna B, Hallett TR, Ivanov A, Janjua S, Meyersohn NM, Staziaki PV, Achenbach S, Ferencik M, Douglas PS, Hoffmann U, Lu MT (2020)

Publication Type: Journal article

Publication year: 2020

Journal

Journal of the American College of Cardiology : Cardiovascular imaging Elsevier

Book Volume: 13

Pages Range: 1534-1545

Journal Issue: 7

DOI: 10.1016/j.jcmg.2019.09.012

Abstract

Objectives: The purpose of this study was to compare Coronary Artery Disease Reporting and Data System (CAD-RADS) to traditional stenosis categories and the coronary artery calcium score (CACS) for predicting cardiovascular events in patients with stable chest pain and suspected coronary artery disease (CAD). Background: The 2016 CAD-RADS has been established to standardize the reporting of CAD on coronary CT angiography (CTA). Methods: PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial participants’ CTAs were assessed by a central CT core laboratory for CACS, traditional stenosis-based categories, and modified CAD-RADS grade including high-risk coronary plaque (HRP) features. Traditional stenosis categories and CAD-RADS grade were compared for the prediction of the composite endpoint of death, myocardial infarction, or hospitalization for unstable angina over a median follow-up of 25 months. Incremental prognostic value over traditional risk factors and CACS was assessed. Results: In 3,840 eligible patients (mean age: 60.4 ± 8.2 years; 49% men), 3.0% (115) experienced events. CAD-RADS (concordance statistic [C-statistic] 0.747) had significantly higher discriminatory value than traditional stenosis-based assessments (C-statistic 0.698 to 0.717; all p for comparison ≤0.001). With no plaque (CAD-RADS 0) as the baseline, the hazard ratio (HR) for an event increased from 2.43 (95% confidence interval [CI]: 1.16 to 5.08) for CAD-RADS 1 to 21.84 (95% CI: 8.63 to 55.26) for CAD-RADS 4b and 5. In stepwise nested models, CAD-RADS added incremental prognostic value beyond ASCVD risk score and CACS (C-statistic 0.776 vs. 0.682; p < 0.001), and added incremental value persisted in all CACS strata. Conclusions: These data from a large representative contemporary cohort of patients undergoing coronary CTA for stable chest pain support the prognostic value of CAD-RADS as a standard reporting system for coronary CTA.

Authors with CRIS profile

Stephan Achenbach Lehrstuhl für Innere Medizin II

Involved external institutions

Veterans Affairs Healthcare System Boston and Harvard Medical School US United States (USA) (US) The Lundquist Institute for Biomedical Innovation US United States (USA) (US) Duke University Health System US United States (USA) (US)

How to cite

APA:

Bittner, D.O., Mayrhofer, T., Budoff, M., Szilveszter, B., Foldyna, B., Hallett, T.R.,... Lu, M.T. (2020). Prognostic Value of Coronary CTA in Stable Chest Pain: CAD-RADS, CAC, and Cardiovascular Events in PROMISE. Journal of the American College of Cardiology : Cardiovascular imaging, 13(7), 1534-1545. https://doi.org/10.1016/j.jcmg.2019.09.012

MLA:

Bittner, Daniel O., et al. "Prognostic Value of Coronary CTA in Stable Chest Pain: CAD-RADS, CAC, and Cardiovascular Events in PROMISE." Journal of the American College of Cardiology : Cardiovascular imaging 13.7 (2020): 1534-1545.

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