Prognostic value of CAD-RADS classification by coronary CTA in patients with suspected CAD

Abstract

Background The study sought to compare Coronary Artery Disease Reporting and Data System (CAD-RADS) classification with traditional coronary artery disease (CAD) classifications and Duke Prognostic CAD Index for predicting the risk of all-cause mortality in patients with suspected CAD. Methods 9625 consecutive suspected CAD patients were assessed by coronary CTA for CAD-RADS classification, traditional CAD classifications and Duke Prognostic CAD Index. Kaplan–Meier and multivariable Cox models were used to estimate all-cause mortality. Discriminatory ability of classifications was assessed using time dependent receiver-operating characteristic (ROC) curves and The Hosmer–Lemeshow goodness-of-fit test was employed to evaluate calibration. Results A total of 540 patients died from all causes with a median follow-up of 4.3 ± 2.1 years. Kaplan–Meier survival curves showed the cumulative events increased significantly associated with CAD-RADS, three traditional CAD classifications and Duke Prognostic CAD Index. In multivariate Cox regressions, the risk for the all-cause death increased from HR 0.861 (95% CI 0.420–1.764) for CAD-RADS 1 to HR 2.761 (95% CI 1.961–3.887) for CAD-RADS 4B&5, using CAD-RADS 0 as the reference group. The relative HRs for all-cause death increased proportionally with the grades of the three traditional CAD classifications and Duke Prognostic CAD Index. The area under the time dependent ROC curve for prediction of all-cause death was 0.7917, 0.7805, 0.7991for CAD-RADS in 1 year, 3 year, 5 year, respectively, which was non-inferior to the traditional CAD classifications and Duke Prognostic CAD Index. Conclusions The CAD-RADS classification provided important prognostic information for patients with suspected CAD with noninvasive evaluation, which was non-inferior than Duke Prognostic CAD Index and traditional stenosis-based grading schemes in prognostic value of all-cause mortality. Traditional and simplest CAD classification should be preferable, given the more number of groups and complexity of CAD-RADS and Duke prognostic index, without using more time consuming classification.

Prognostic value of coronary CTA-based classifications for predicting major events without obstructive coronary artery disease

“…Our previous study has showed that the prevalence of non-obstructive CAD is higher than that of obstructive CAD 13 , which is consistence with other multicenter studies 4 , 5 . Moreover, recent studies have suggested that the majority of cardiovascular events and all-cause mortality occurred among patients with non-obstructive CAD 5 , 13 . Thus, it is necessary to provide further risk stratification for the evaluation and management of non-obstructive CAD.…”

“…This study population consisted of 5991 consecutive patients with suspected CAD who were performed coronary CTA for clinical reasons between June 2017 and December 2019 at two hospitals in Wuhan, China. We have previous reported the details of the rational of the study and included parts of the patients 13 . We used the first coronary CTA examination to characterize CAD extent if multiple coronary CTAs were performed during the study period.…”

Performance of machine learning-based coronary computed tomography angiography for selecting revascularization candidates

“…The coronary arteries with a diameter ≥2 mm were evaluated for luminal narrowing. The standardized Coronary Artery Disease-Reporting and Data System (CAD-RADS) classification was reported in our recent researches (14,18,20).…”

Coronary artery calcification—does it predict the CAD-RADS category?

“…Observed vulnerable plaque in CCTA (modifier V in CAD-RADS) was not excluded, nor was it applied in the reporting since it was observed not to contribute incrementally to prognostic function [ 4 , 22 ]. Also, both CAD-RADS 4A and 4B were assessed as CAD-RADS 4, not as separate categories.…”

“…This system describes the maximal degree of coronary artery stenosis in percent as follows: CAD-RADS 0: 0%, CAD-RADS 1: 1–24%, CAD-RADS 2: 25–49%, CAD-RADS 3: 50–69%, CAD-RADS 4A: 70–99%, CAD-RADS 4B: left main > 50% or three-vessel obstruction, CAD-RADS 5: 100%. It has now been accepted as the standard method of reporting CCTA results, proven to be superior in diagnostic and prognostic aspects to previous methods [ 4 – 7 ].…”