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.
N1 - Funding Information:
Funding for this research was supported by NIH-NHLBI (5T32HL007745-20). Dr. Al-Mallah has received Speakers Bureau fees from GE Healthcare and Phillips. Dr. Andreini has received personal fees from GE Healthcare. Dr. Berman has been a consultant with Molecular Dynamics; has been employed and receives royalties from Cedars-Sinai Medical Center; and has received a grant with Bayer Pharmaceutical. Dr. Budoff has received grants from NIH and GE. Dr. Chow has received research support from GE Healthcare and CV Diagnostic; and educational support from TeraRecon Inc. Dr. Hausleiter has received personal fees from Abbott Vascular and Edwards Lifesciences. Dr. Leipsic has received personal fees from HeartFlow Inc., Circle CVI, GE Healthcare, Samsung, and Phillips. Dr. Min has received funding from NIH/NHLBI under grant RO1 HL115150; and has reported affiliations with MDDX, HeartFlow Inc., and Arineta. Dr. Pontone has received grants and speaker fees from GE Healthcare; speakers fees from Medtronic and Bracco; and grants from HeartFlow Inc. Dr. Raff has received a research grant from HeartFlow Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. William Weintraub, MD, served as the Guest Editor for this paper.
Publisher Copyright:
© 2018 American College of Cardiology Foundation
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
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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U2 - 10.1016/j.jcmg.2017.08.026
DO - 10.1016/j.jcmg.2017.08.026
M3 - Article
C2 - 29301713
AN - SCOPUS:85039933304
VL - 11
SP - 78
EP - 89
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
SN - 1936-878X
IS - 1
ER -