Joe X Xie1, Ricardo C Cury2, Jonathon Leipsic3, Matthew T Crim1, Daniel S Berman4, Heidi Gransar4, Matthew J Budoff5, Stephan Achenbach6, Bríain Ó Hartaigh7, Tracy Q Callister8, Hugo Marques9, Ronen Rubinshtein10, Mouaz H Al-Mallah11, Daniele Andreini12, Gianluca Pontone12, Filippo Cademartiri13, Erica Maffei13, Kavitha Chinnaiyan14, Gilbert Raff14, Martin Hadamitzky15, Joerg Hausleiter16, Gudrun Feuchtner17, Allison Dunning18, Augustin DeLago19, Yong-Jin Kim20, Philipp A Kaufmann21, Todd C Villines22, Benjamin J W Chow23, Niree Hindoyan7, Millie Gomez7, Fay Y Lin7, Erica Jones7, James K Min7, Leslee J Shaw24. 1. Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia. 2. Division of Cardiology, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida. 3. Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada. 4. Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California. 5. Division of Cardiology, Harbor UCLA Medical Center, Los Angeles, California. 6. Division of Cardiology, University of Erlangen, Erlangen, Germany. 7. Division of Cardiology, Weill Cornell Medical College and the NewYork-Presbyterian Hospital, New York, New York. 8. Division of Cardiology, Tennessee Heart and Vascular Institute, Hendersonville, Tennessee. 9. Division of Cardiology, Hospital da Luz, Lisbon, Portugal. 10. Division of Cardiology, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. 11. Division of Cardiology, Henry Ford Hospital, Detroit, Michigan. 12. Division of Cardiology, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy. 13. Division of Cardiology, Department of Radiology/Centre de Recherche, Montreal Heart Institute/Universitè de Montreal, Montreal, Quebec, Canada. 14. Division of Cardiology, William Beaumont Hospital, Royal Oaks, Michigan. 15. Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany. 16. Division of Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany. 17. Division of Cardiology, Medical University of Innsbruck, Innsbruck, Austria. 18. Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina. 19. Division of Cardiology, Capitol Cardiology Associates, Albany, New York. 20. Division of Cardiology, Seoul National University Hospital, Seoul, South Korea. 21. Division of Cardiology, University Hospital, Zurich, Switzerland. 22. Division of Cardiology, Walter Reed Medical Center, Washington, DC. 23. Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. 24. Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia. Electronic address: lshaw3@emory.edu.
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.
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.
Authors: Yi Xue; Min Wen Zheng; Yang Hou; Fan Zhou; Jian Hua Li; Yi Ning Wang; Chun Yu Liu; Chang Sheng Zhou; Jia Yin Zhang; Meng Meng Yu; Bo Zhang; Dai Min Zhang; Yan Yi; Lei Xu; Xiu Hua Hu; Guang Ming Lu; Chun Xiang Tang; Long Jiang Zhang Journal: Eur Radiol Date: 2022-01-12 Impact factor: 5.315
Authors: Daniel O Bittner; Thomas Mayrhofer; Matt Budoff; Balint Szilveszter; Borek Foldyna; Travis R Hallett; Alexander Ivanov; Sumbal Janjua; Nandini M Meyersohn; Pedro V Staziaki; Stephan Achenbach; Maros Ferencik; Pamela S Douglas; Udo Hoffmann; Michael T Lu Journal: JACC Cardiovasc Imaging Date: 2019-11-13
Authors: Jagat Narula; Y Chandrashekhar; Amir Ahmadi; Suhny Abbara; Daniel S Berman; Ron Blankstein; Jonathon Leipsic; David Newby; Edward D Nicol; Koen Nieman; Leslee Shaw; Todd C Villines; Michelle Williams; Harvey S Hecht Journal: J Cardiovasc Comput Tomogr Date: 2020-11-20