Standardized reporting systems for computed tomography coronary angiography and calcium scoring: A real-world validation of CAD-RADS and CAC-DRS in patients with stable chest pain

Williams, Michelle; Moss, Alastair J; Dweck, Marc R; Hunter, Amanda; Pawade, Tania; Adamson, Philip D; Shah, Anoop; Alam, Shirjel; Maroules, Christopher D.; Beek, Edwin Jr van; Cury, Ricardo C.; Nicol, Edward; Newby, David E.; Roditi, Giles

doi:10.1016/j.jcct.2019.07.010

Cited by 38 publications

(28 citation statements)

References 34 publications

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Section: Discussionsupporting

confidence: 93%

“…These patients had 3 vessel disease ≥ 70% or left main stem stenosis ≥ 50%. This finding was in keeping with other researches which have reported that the presence of obstructive CAD is associated with a poorer prognosis [16][17][18][19]. The Duke Prognostic CAD Index was originally derived for important prognostic aspects with a more detailed information of coronary anatomy than the traditional CAD classification of normal, one, two and three-vessel disease, and has been widely used to assess the mortality risk for treatment modalities based on the severity of coronary disease severity [20,21].…”

Section: Discussionsupporting

confidence: 83%

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Prognostic value of CAD-RADS classification by coronary CTA in patients with suspected CAD

Huang

Zhang

Jin

et al. 2021

BMC Cardiovasc Disord

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Background The study sought to compare Coronary Artery Disease Reporting and Data System (CAD-RADS) classification with traditional coronary artery disease (CAD) classifications and Duke Prognostic CAD Index for predicting the risk of all-cause mortality in patients with suspected CAD. Methods 9625 consecutive suspected CAD patients were assessed by coronary CTA for CAD-RADS classification, traditional CAD classifications and Duke Prognostic CAD Index. Kaplan–Meier and multivariable Cox models were used to estimate all-cause mortality. Discriminatory ability of classifications was assessed using time dependent receiver-operating characteristic (ROC) curves and The Hosmer–Lemeshow goodness-of-fit test was employed to evaluate calibration. Results A total of 540 patients died from all causes with a median follow-up of 4.3 ± 2.1 years. Kaplan–Meier survival curves showed the cumulative events increased significantly associated with CAD-RADS, three traditional CAD classifications and Duke Prognostic CAD Index. In multivariate Cox regressions, the risk for the all-cause death increased from HR 0.861 (95% CI 0.420–1.764) for CAD-RADS 1 to HR 2.761 (95% CI 1.961–3.887) for CAD-RADS 4B&5, using CAD-RADS 0 as the reference group. The relative HRs for all-cause death increased proportionally with the grades of the three traditional CAD classifications and Duke Prognostic CAD Index. The area under the time dependent ROC curve for prediction of all-cause death was 0.7917, 0.7805, 0.7991for CAD-RADS in 1 year, 3 year, 5 year, respectively, which was non-inferior to the traditional CAD classifications and Duke Prognostic CAD Index. Conclusions The CAD-RADS classification provided important prognostic information for patients with suspected CAD with noninvasive evaluation, which was non-inferior than Duke Prognostic CAD Index and traditional stenosis-based grading schemes in prognostic value of all-cause mortality. Traditional and simplest CAD classification should be preferable, given the more number of groups and complexity of CAD-RADS and Duke prognostic index, without using more time consuming classification.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 83%

Prognostic value of CAD-RADS classification by coronary CTA in patients with suspected CAD

Huang

Zhang

Jin

et al. 2021

BMC Cardiovasc Disord

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“…Lastly, there is increasing demand for standardised reporting of CTCA findings. The CAD-RADS or ESCR smart reporting tool are standardised communication and reporting methods that link CTCA findings to further management recommendations and provide additional prognostic information of future CAD events [ 11 , 23 , 24 ]. Although the majority of hospital organisations (76.2%) use a standard report, only a minority (14.3%) used the CAD-RADS reporting system.…”

Section: Discussionmentioning

confidence: 99%

The impact and challenges of implementing CTCA according to the 2019 ESC guidelines on chronic coronary syndromes: a survey and projection of CTCA services in the Netherlands

et al. 2021

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Background The 2019 ESC-guidelines on chronic coronary syndromes (ESC-CCS) recommend computed tomographic coronary angiography (CTCA) or non-invasive functional imaging instead of exercise ECG as initial test to diagnose obstructive coronary artery disease. Since impact and challenges of these guidelines are unknown, we studied the current utilisation of CTCA-services, status of CTCA-protocols and modeled the expected impact of these guidelines in the Netherlands. Methods and results A survey on current practice and CTCA utilisation was disseminated to every Dutch hospital organisation providing outpatient cardiology care and modeled the required CTCA capacity for implementation of the ESC guideline, based on these national figures and expert consensus. Survey response rate was 100% (68/68 hospital organisations). In 2019, 63 hospital organisations provided CTCA-services (93%), CTCA was performed on 99 CTCA-capable CT-scanners, and 37,283 CTCA-examinations were performed. Between the hospital organisations, we found substantial variation considering CTCA indications, CTCA equipment and acquisition and reporting standards. To fully implement the new ESC guideline, our model suggests that 70,000 additional CTCA-examinations would have to be performed in the Netherlands. Conclusions Despite high national CTCA-services coverage in the Netherlands, a substantial increase in CTCA capacity is expected to be able to implement the 2019 ESC-CCS recommendations on the use of CTCA. Furthermore, the results of this survey highlight the importance to address variations in image acquisition and to standardise the interpretation and reporting of CTCA, as well as to establish interdisciplinary collaboration and organisational alignment.

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“…CAD-RADS is a standardised radiological reporting system dating since 2016, and there are only a few studies published in the area of cardiac imaging using the CAD-RADS score 28–32. It is used to quantify coronary artery stenosis in patients with suspected or known coronary artery disease to provide a basis for further investigation, diagnosis, management and treatment, substantially reducing human error and improving data integrity 14…”

Section: Discussionmentioning

confidence: 99%

Association between cardiovascular risk factors and coronary artery disease assessed using CAD-RADS classification: a cross-sectional study in Romanian population

Popa

Petresc²,

Cătană³

et al. 2020

BMJ Open

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ObjectivesThis study aimed to evaluate the association between cardiovascular risk factors and Coronary Artery Disease—Reporting and Data System (CAD-RADS) score in the Romanian population. CAD-RADS is a new, standardised method to assess coronary artery disease (CAD) using coronary CT angiography (CCTA).DesignA cross-sectional observational, patient-based study.SettingReferred imaging centre for CAD in Transylvania, Romania.ParticipantsWe retrospectively reviewed 674 patients who underwent CCTA between January 2017 and August 2018. The exclusion criteria included: previously known CAD, defined as prior myocardial infarction, percutaneous coronary intervention or coronary artery bypass graft surgery (n=91), cardiac CT for other than evaluation of possible CAD (n=85), significant arrhythmias compromising imaging quality (n=23). Finally, 475 patients fulfilled the inclusion criteria.MethodsDemographical, clinical and CCTA characteristics of the patients were obtained. CAD was evaluated using CAD-RADS score. Obstructive CAD was defined as ≥50% stenosis of ≥1 coronary segment on CCTA.ResultsWe evaluated the association between risk factors and CAD-RADS score in univariate and multivariable analysis. We divided the patients into two groups according to the CAD-RADS system: group 1: CAD-RADS score between 0 and 2 (stenosis <50%) and group 2: CAD-RADS score ≥3 (stenosis ≥50%). On univariate analysis, male gender, age, hypertension, dyslipidaemia, smoking and diabetes mellitus were positively associated with a CAD-RADS score ≥3. The multivariate analysis showed that male sex, age, dyslipidaemia, hypertension and smoking were independently associated with obstructive CAD.ConclusionThis study demonstrated a significant association between multiple cardiovascular risk factors and a higher coronary atherosclerotic burden assessed using CAD-RADS system in the Romanian population.

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Standardized reporting systems for computed tomography coronary angiography and calcium scoring: A real-world validation of CAD-RADS and CAC-DRS in patients with stable chest pain

Cited by 38 publications

References 34 publications

Prognostic value of CAD-RADS classification by coronary CTA in patients with suspected CAD

Prognostic value of CAD-RADS classification by coronary CTA in patients with suspected CAD

The impact and challenges of implementing CTCA according to the 2019 ESC guidelines on chronic coronary syndromes: a survey and projection of CTCA services in the Netherlands

Association between cardiovascular risk factors and coronary artery disease assessed using CAD-RADS classification: a cross-sectional study in Romanian population

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