Journal article
The Coronary Artery Disease-Reporting and Data System (CAD-RADS): Prognostic and Clinical Implications Associated With Standardized Coronary Computed Tomography Angiography Reporting.
- Xie JX Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
- Cury RC Division of Cardiology, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida.
- Leipsic J Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
- Crim MT Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
- Berman DS Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California.
- Gransar H Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California.
- Budoff MJ Division of Cardiology, Harbor UCLA Medical Center, Los Angeles, California.
- Achenbach S Division of Cardiology, University of Erlangen, Erlangen, Germany.
- Ó Hartaigh B Division of Cardiology, Weill Cornell Medical College and the NewYork-Presbyterian Hospital, New York, New York.
- Callister TQ Division of Cardiology, Tennessee Heart and Vascular Institute, Hendersonville, Tennessee.
- Marques H Division of Cardiology, Hospital da Luz, Lisbon, Portugal.
- Rubinshtein R Division of Cardiology, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
- Al-Mallah MH Division of Cardiology, Henry Ford Hospital, Detroit, Michigan.
- Andreini D Division of Cardiology, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy.
- Pontone G Division of Cardiology, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy.
- Cademartiri F Division of Cardiology, Department of Radiology/Centre de Recherche, Montreal Heart Institute/Universitè de Montreal, Montreal, Quebec, Canada.
- Maffei E Division of Cardiology, Department of Radiology/Centre de Recherche, Montreal Heart Institute/Universitè de Montreal, Montreal, Quebec, Canada.
- Chinnaiyan K Division of Cardiology, William Beaumont Hospital, Royal Oaks, Michigan.
- Raff G Division of Cardiology, William Beaumont Hospital, Royal Oaks, Michigan.
- Hadamitzky M Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany.
- Hausleiter J Division of Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany.
- Feuchtner G Division of Cardiology, Medical University of Innsbruck, Innsbruck, Austria.
- Dunning A Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina.
- DeLago A Division of Cardiology, Capitol Cardiology Associates, Albany, New York.
- Kim YJ Division of Cardiology, Seoul National University Hospital, Seoul, South Korea.
- Kaufmann PA Division of Cardiology, University Hospital, Zurich, Switzerland.
- Villines TC Division of Cardiology, Walter Reed Medical Center, Washington, DC.
- Chow BJW Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
- Hindoyan N Division of Cardiology, Weill Cornell Medical College and the NewYork-Presbyterian Hospital, New York, New York.
- Gomez M Division of Cardiology, Weill Cornell Medical College and the NewYork-Presbyterian Hospital, New York, New York.
- Lin FY Division of Cardiology, Weill Cornell Medical College and the NewYork-Presbyterian Hospital, New York, New York.
- Jones E Division of Cardiology, Weill Cornell Medical College and the NewYork-Presbyterian Hospital, New York, New York.
- Min JK Division of Cardiology, Weill Cornell Medical College and the NewYork-Presbyterian Hospital, New York, New York.
- Shaw LJ Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia. Electronic address: lshaw3@emory.edu.
- 2018-01-06
Published in:
- JACC. Cardiovascular imaging. - 2018
appropriate use
clinical decision support
coronary computed tomography angiography
prognosis
Adult
Aged
Computed Tomography Angiography
Coronary Angiography
Coronary Artery Disease
Coronary Stenosis
Coronary Vessels
Decision Support Systems, Clinical
Decision Support Techniques
Female
Humans
Male
Middle Aged
Predictive Value of Tests
Prognosis
Prospective Studies
Radiology Information Systems
Registries
Risk Assessment
Risk Factors
Severity of Illness Index
English
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.
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.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.jcmg.2017.08.026
- PMID 29301713
- Persistent URL
- https://sonar.ch/global/documents/128446
Statistics
Document views: 17
File downloads: