The Coronary Artery Disease–Reporting and Data System (CAD-RADS): Prognostic and Clinical Implications Associated With Standardized Coronary Computed Tomography Angiography Reporting

Joe X. Xie, Ricardo C. Cury, Jonathon Leipsic, Matthew T. Crim, Daniel S. Berman, Heidi Gransar, Matthew J. Budoff, Stephan Achenbach, Bríain Ó Hartaigh, Tracy Q. Callister, Hugo Marques, Ronen Rubinshtein, Mouaz H. Al-Mallah, Daniele Andreini, Gianluca Pontone, Filippo Cademartiri, Erica Maffei, Kavitha Chinnaiyan, Gilbert Raff, Martin HadamitzkyJoerg Hausleiter, Gudrun Feuchtner, Allison Dunning, Augustin DeLago, Yong Jin Kim, Philipp A. Kaufmann, Todd C. Villines, Benjamin J.W. Chow, Niree Hindoyan, Millie Gomez, Fay Y. Lin, Erica Jones, James K. Min, Leslee J. Shaw

Research output: Contribution to journalArticle

19 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)78-89
Number of pages12
JournalJACC: Cardiovascular Imaging
Volume11
Issue number1
DOIs
StatePublished - Jan 2018
Externally publishedYes

Fingerprint

Information Systems
Coronary Vessels
Coronary Artery Disease
Coronary Angiography
ROC Curve
Computed Tomography Angiography
Myocardial Infarction
Clinical Decision Support Systems
Coronary Stenosis
Health Policy
Proportional Hazards Models
Catheterization
Disease-Free Survival
Registries
Referral and Consultation
Odds Ratio
Guidelines
Delivery of Health Care

Keywords

  • appropriate use
  • clinical decision support
  • coronary computed tomography angiography
  • prognosis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

The Coronary Artery Disease–Reporting and Data System (CAD-RADS) : Prognostic and Clinical Implications Associated With Standardized Coronary Computed Tomography Angiography Reporting. / Xie, Joe X.; Cury, Ricardo C.; Leipsic, Jonathon; Crim, Matthew T.; Berman, Daniel S.; Gransar, Heidi; Budoff, Matthew J.; Achenbach, Stephan; Ó Hartaigh, Bríain; Callister, Tracy Q.; Marques, Hugo; Rubinshtein, Ronen; Al-Mallah, Mouaz H.; Andreini, Daniele; Pontone, Gianluca; Cademartiri, Filippo; Maffei, Erica; Chinnaiyan, Kavitha; Raff, Gilbert; Hadamitzky, Martin; Hausleiter, Joerg; Feuchtner, Gudrun; Dunning, Allison; DeLago, Augustin; Kim, Yong Jin; Kaufmann, Philipp A.; Villines, Todd C.; Chow, Benjamin J.W.; Hindoyan, Niree; Gomez, Millie; Lin, Fay Y.; Jones, Erica; Min, James K.; Shaw, Leslee J.

In: JACC: Cardiovascular Imaging, Vol. 11, No. 1, 01.2018, p. 78-89.

Research output: Contribution to journalArticle

Xie, JX, Cury, RC, Leipsic, J, Crim, MT, Berman, DS, Gransar, H, Budoff, MJ, Achenbach, S, Ó Hartaigh, B, Callister, TQ, Marques, H, Rubinshtein, R, Al-Mallah, MH, Andreini, D, Pontone, G, Cademartiri, F, Maffei, E, Chinnaiyan, K, Raff, G, Hadamitzky, M, Hausleiter, J, Feuchtner, G, Dunning, A, DeLago, A, Kim, YJ, Kaufmann, PA, Villines, TC, Chow, BJW, Hindoyan, N, Gomez, M, Lin, FY, Jones, E, Min, JK & Shaw, LJ 2018, 'The Coronary Artery Disease–Reporting and Data System (CAD-RADS): Prognostic and Clinical Implications Associated With Standardized Coronary Computed Tomography Angiography Reporting', JACC: Cardiovascular Imaging, vol. 11, no. 1, pp. 78-89. https://doi.org/10.1016/j.jcmg.2017.08.026
Xie, Joe X. ; Cury, Ricardo C. ; Leipsic, Jonathon ; Crim, Matthew T. ; Berman, Daniel S. ; Gransar, Heidi ; Budoff, Matthew J. ; Achenbach, Stephan ; Ó Hartaigh, Bríain ; Callister, Tracy Q. ; Marques, Hugo ; Rubinshtein, Ronen ; Al-Mallah, Mouaz H. ; Andreini, Daniele ; Pontone, Gianluca ; Cademartiri, Filippo ; Maffei, Erica ; Chinnaiyan, Kavitha ; Raff, Gilbert ; Hadamitzky, Martin ; Hausleiter, Joerg ; Feuchtner, Gudrun ; Dunning, Allison ; DeLago, Augustin ; Kim, Yong Jin ; Kaufmann, Philipp A. ; Villines, Todd C. ; Chow, Benjamin J.W. ; Hindoyan, Niree ; Gomez, Millie ; Lin, Fay Y. ; Jones, Erica ; Min, James K. ; Shaw, Leslee J. / The Coronary Artery Disease–Reporting and Data System (CAD-RADS) : Prognostic and Clinical Implications Associated With Standardized Coronary Computed Tomography Angiography Reporting. In: JACC: Cardiovascular Imaging. 2018 ; Vol. 11, No. 1. pp. 78-89.
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title = "The Coronary Artery Disease–Reporting and Data System (CAD-RADS): Prognostic and Clinical Implications Associated With Standardized Coronary Computed Tomography Angiography Reporting",
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.",
keywords = "appropriate use, clinical decision support, coronary computed tomography angiography, prognosis",
author = "Xie, {Joe X.} and Cury, {Ricardo C.} and Jonathon Leipsic and Crim, {Matthew T.} and Berman, {Daniel S.} and Heidi Gransar and Budoff, {Matthew J.} and Stephan Achenbach and {{\'O} Hartaigh}, Br{\'i}ain and Callister, {Tracy Q.} and Hugo Marques and Ronen Rubinshtein and Al-Mallah, {Mouaz H.} and Daniele Andreini and Gianluca Pontone and Filippo Cademartiri and Erica Maffei and Kavitha Chinnaiyan and Gilbert Raff and Martin Hadamitzky and Joerg Hausleiter and Gudrun Feuchtner and Allison Dunning and Augustin DeLago and Kim, {Yong Jin} and Kaufmann, {Philipp A.} and Villines, {Todd C.} and Chow, {Benjamin J.W.} and Niree Hindoyan and Millie Gomez and Lin, {Fay Y.} and Erica Jones and Min, {James K.} and Shaw, {Leslee J.}",
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TY - JOUR

T1 - The Coronary Artery Disease–Reporting and Data System (CAD-RADS)

T2 - Prognostic and Clinical Implications Associated With Standardized Coronary Computed Tomography Angiography Reporting

AU - Xie, Joe X.

AU - Cury, Ricardo C.

AU - Leipsic, Jonathon

AU - Crim, Matthew T.

AU - Berman, Daniel S.

AU - Gransar, Heidi

AU - Budoff, Matthew J.

AU - Achenbach, Stephan

AU - Ó Hartaigh, Bríain

AU - Callister, Tracy Q.

AU - Marques, Hugo

AU - Rubinshtein, Ronen

AU - Al-Mallah, Mouaz H.

AU - Andreini, Daniele

AU - Pontone, Gianluca

AU - Cademartiri, Filippo

AU - Maffei, Erica

AU - Chinnaiyan, Kavitha

AU - Raff, Gilbert

AU - Hadamitzky, Martin

AU - Hausleiter, Joerg

AU - Feuchtner, Gudrun

AU - Dunning, Allison

AU - DeLago, Augustin

AU - Kim, Yong Jin

AU - Kaufmann, Philipp A.

AU - Villines, Todd C.

AU - Chow, Benjamin J.W.

AU - Hindoyan, Niree

AU - Gomez, Millie

AU - Lin, Fay Y.

AU - Jones, Erica

AU - Min, James K.

AU - Shaw, Leslee J.

PY - 2018/1

Y1 - 2018/1

N2 - 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.

AB - 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.

KW - appropriate use

KW - clinical decision support

KW - coronary computed tomography angiography

KW - prognosis

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