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Invasive coronary angiography findings across the CAD-RADS classification spectrum

Gaston A Rodriguez-Granillo1, Patricia Carrascosa2, Alejandro Goldsmit3

  • 1Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ, Buenos Aires, Argentina. grodriguezgranillo@gmail.com.

The International Journal of Cardiovascular Imaging
|June 23, 2019
PubMed

Insights

The Coronary Artery Disease Reporting and Data System (CAD-RADS) may not fully capture coronary artery disease complexity. Invasive coronary angiography reveals diverse lesion distributions and complexities within similar CAD-RADS classifications, especially in high-risk patients.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • The Coronary Artery Disease Reporting and Data System (CAD-RADS) is a recent classification system for coronary artery disease (CAD) evaluated by computed tomography.
  • CAD-RADS primarily assesses stenosis severity but may not fully represent the intricate spatial distribution, burden, and complexity of CAD lesions.
  • Understanding the limitations of CAD-RADS is crucial for accurate patient stratification and treatment planning in cardiovascular medicine.

Purpose of the Study:

  • To investigate the relationship between the CAD-RADS classification and the spatial distribution, burden, and complexity of coronary artery lesions.
  • To compare CAD-RADS findings with detailed anatomical information obtained from invasive coronary angiography (ICA).
  • To evaluate whether CAD-RADS adequately reflects the heterogeneity of coronary anatomy in patients with significant coronary artery disease.

Main Methods:

  • A study population of stable patients who underwent both coronary computed tomography angiography (CCTA) and ICA was retrospectively analyzed.
  • Patients were categorized using the established CAD-RADS criteria (0 to 5).
  • Invasive coronary angiography findings were used to calculate the SYNTAX score and the CAD extension index, assessing lesion complexity and extent.

Main Results:

  • Significant correlations were found between CAD-RADS categories and both the SYNTAX score (p < 0.0001) and the CAD extension index (p < 0.0001).
  • However, substantial variability in coronary anatomy complexity was observed among patients within the same CAD-RADS categories, particularly for CAD-RADS ≥ 4A.
  • In patients with CAD-RADS 5 (total occlusion), a significant proportion (30%) involved distal segments or secondary branches, and 30% had concomitant non-extensive severe disease.

Conclusions:

  • While CAD-RADS correlates with lesion severity and complexity, it may not fully encompass the spatial distribution and intricate anatomical variations of coronary artery disease.
  • The study highlights the heterogeneity within CAD-RADS classifications, suggesting that additional imaging or clinical parameters might be needed for comprehensive risk assessment.
  • Invasive coronary angiography provides a more detailed assessment of coronary anatomy complexity, which can differ significantly even within similar CAD-RADS categories.

Keywords:
Computed tomographyCoronary artery stenosisPlaque burdenSYNTAX score

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