Michelle C Williams1, Alastair Moss2, Marc Dweck2, Amanda Hunter2, Tania Pawade2, Philip D Adamson3, Anoop S V Shah2, Shirjel Alam2, Christopher D Maroules4, Edwin Jr van Beek5, Ricardo Cury6, Edward D Nicol7, David E Newby8, Giles Roditi9. 1. University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK. Electronic address: https://twitter.com/imagingmedsci. 2. University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK. 3. University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK; Christchurch Heart Institute, University of Otago, Christchurch, New Zealand. 4. Department of Radiology, Naval Medical Center, Portsmouth, VA, USA . 5. Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK. 6. Miami Cardiac and Vascular Institute, Baptist Health of South Florida, Miami, FL, USA. 7. Royal Brompton and Harefield NHS Foundation Trust Departments of Cardiology and Radiology, London, UK; National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, UK. 8. University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK. 9. Glasgow Clinical Research Imaging Facility, Queen Elizabeth University Hospital, Glasgow, Scotland, UK; Glasgow University, Glasgow, Scotland, UK.
Abstract
OBJECTIVES: To assess the prognostic implications of standardized reporting systems for coronary computed tomography angiography (CCTA) and coronary artery calcium scores (CACS) in patients with stable chest pain. BACKGROUND: The Coronary Artery Disease Reporting And Data System (CAD-RADS) and Coronary Artery Calcium - Data and Reporting System (CAC-DRS) aim to improve communication of CACS and CCTA results, but its influence on prognostication is unknown. METHODS: Images from 1769 patients who underwent CCTA as part of the Scottish Computed Tomography of the HEART (SCOT-HEART) multi-center randomized controlled trial were assessed. CACS were classified as CAC-DRS 0 to 3 based on Agatston scores. CCTA were classified as CAD-RADS 0 to 5 based on the most clinically relevant finding per patient. The primary outcome was the five-year events of fatal and non-fatal myocardial infarction. RESULTS: Patients had a mean age of 58 ± 10 years and 56% were male. CAC-DRS 0, 1, 2 and 3 occurred in 642 (36%), 510 (29%), 239 (14%) and 379 (21%) patients respectively. CAD-RADS 0, 1, 2, 3, 4A, 4B and 5 occurred in 622 (35%), 327 (18%), 211 (12%), 165 (9%), 221 (12%), 42 (2%) and 181 (10%) patients respectively. Patients classified as CAC-DRS 3 were at an increased risk of fatal or non-fatal myocardial infarction compared to CAC-DRS 0 patients (hazard ratio (HR) 9.41; 95% confidence interval (CI) 3.24, 27.31; p < 0.001). Patients with higher CAD-RADS categories were at an increased risk of fatal or non-fatal myocardial infarction, with patients classified as CAD-RADS 4B at the highest risk compared to CAD-RADS 0 patients (HR 19.14; 95% CI 4.28, 85.53; p < 0.001). CONCLUSION: Patients with higher CAC-DRS and CAD-RADS scores were at increased risk of subsequent fatal and non-fatal myocardial infarction. This confirms that the classification provides additional prognostic discrimination for future coronary heart disease events.
OBJECTIVES: To assess the prognostic implications of standardized reporting systems for coronary computed tomography angiography (CCTA) and coronary artery calcium scores (CACS) in patients with stable chest pain. BACKGROUND: The Coronary Artery Disease Reporting And Data System (CAD-RADS) and Coronary Artery Calcium - Data and Reporting System (CAC-DRS) aim to improve communication of CACS and CCTA results, but its influence on prognostication is unknown. METHODS: Images from 1769 patients who underwent CCTA as part of the Scottish Computed Tomography of the HEART (SCOT-HEART) multi-center randomized controlled trial were assessed. CACS were classified as CAC-DRS 0 to 3 based on Agatston scores. CCTA were classified as CAD-RADS 0 to 5 based on the most clinically relevant finding per patient. The primary outcome was the five-year events of fatal and non-fatal myocardial infarction. RESULTS: Patients had a mean age of 58 ± 10 years and 56% were male. CAC-DRS 0, 1, 2 and 3 occurred in 642 (36%), 510 (29%), 239 (14%) and 379 (21%) patients respectively. CAD-RADS 0, 1, 2, 3, 4A, 4B and 5 occurred in 622 (35%), 327 (18%), 211 (12%), 165 (9%), 221 (12%), 42 (2%) and 181 (10%) patients respectively. Patients classified as CAC-DRS 3 were at an increased risk of fatal or non-fatal myocardial infarction compared to CAC-DRS 0 patients (hazard ratio (HR) 9.41; 95% confidence interval (CI) 3.24, 27.31; p < 0.001). Patients with higher CAD-RADS categories were at an increased risk of fatal or non-fatal myocardial infarction, with patients classified as CAD-RADS 4B at the highest risk compared to CAD-RADS 0 patients (HR 19.14; 95% CI 4.28, 85.53; p < 0.001). CONCLUSION: Patients with higher CAC-DRS and CAD-RADS scores were at increased risk of subsequent fatal and non-fatal myocardial infarction. This confirms that the classification provides additional prognostic discrimination for future coronary heart disease events.
Authors: Todd C Villines; Subhi J Al'Aref; Daniele Andreini; Marcus Y Chen; Andrew D Choi; Carlo N De Cecco; Damini Dey; James P Earls; Maros Ferencik; Heidi Gransar; Harvey Hecht; Jonathon A Leipsic; Michael T Lu; Mohamed Marwan; Pál Maurovich-Horvat; Edward Nicol; Gianluca Pontone; Jonathan Weir-McCall; Seamus P Whelton; Michelle C Williams; Armin Arbab-Zadeh; Gudrun M Feuchtner Journal: J Cardiovasc Comput Tomogr Date: 2021-02-22
Authors: T P W van den Boogert; B E P M Claessen; S M Boekholdt; T Leiner; R Vliegenthart; S F Schuiling; J R Timmer; S C A M Bekkers; M Voskuil; H J Siebelink; W van Es; H J Lamb; M Prokop; P Damman; J Stoker; H C Willems; J P Henriques; R N Planken Journal: Insights Imaging Date: 2021-12-18
Authors: Gudrun M Feuchtner; Fabian Plank; Christoph Beyer; Fabian Barbieri; Gerlig Widmann; Philipp Spitaler; Wolfgang Dichtl Journal: J Clin Med Date: 2022-07-29 Impact factor: 4.964
Authors: Michelle C Williams; Jonathan Weir-McCall; Alastair J Moss; Matthias Schmitt; James Stirrup; Ben Holloway; Deepa Gopalan; Aparna Deshpande; Gareth Morgan Hughes; Bobby Agrawal; Edward Nicol; Giles Roditi; James Shambrook; Russell Bull Journal: BJR Open Date: 2022-03-11