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 receiver-operating characteristic (ROC) curves and the Hosmer-Lemeshow goodness-of-fit test.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 to 1.764) for CAD-RADS 1 to HR 2.761 (95% CI: 1.961 to 3.887) for CAD-RADS 4B&5, using CAD-RADS 0 as the reference group. The relative HR s for all-cause death increased proportionally with the grades of the three traditional CAD classifications and Duke Prognostic CAD Index. The ROC curve for prediction of all cause death was 0.7927 for CAD-RADS, which was non-inferior to the traditional CAD classifications and Duke Prognostic CAD Index.Conclusions: 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.