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Functional CAD-RADS using FFRCT on therapeutic management and prognosis in patients with coronary artery disease

Chun Xiang Tang1, Hong Yan Qiao1, Xiao Lei Zhang1

  • 1Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.

European Radiology
|March 8, 2022
PubMed

Insights

A new functional Coronary Artery Disease-Reporting and Data System (CAD-RADS) using FFR_CT improves therapeutic decisions and predicts prognosis in CAD patients. This functional CAD-RADS offers superior guidance over anatomical CAD-RADS for better patient outcomes.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • Coronary Artery Disease (CAD) management relies on accurate risk stratification.
  • Anatomical Coronary Artery Disease-Reporting and Data System (CAD-RADS) using coronary CT angiography (CCTA) provides anatomical information.
  • Functional assessment using fractional flow reserve (FFR) is crucial for guiding treatment but is invasive.

Purpose of the Study:

  • To introduce a novel functional CAD-RADS category system integrating CCTA-derived fractional flow reserve (FFR_CT).
  • To assess the impact of this functional CAD-RADS on therapeutic decision-making.
  • To validate the prognostic value of functional CAD-RADS in patients with CAD.

Main Methods:

  • Proposed a novel functional CAD-RADS system.
  • Evaluated its performance in guiding treatment strategies against actual clinical treatment in a retrospective cohort (n=466) with CCTA and invasive FFR.
  • Calculated Net Reclassification Improvement (NRI) against anatomical CAD-RADS.
  • Assessed prognostic value in a prospective two-arm cohort (FFR_CT vs. CCTA) over 1-year follow-up using Cox hazard proportional models.

Main Results:

  • Functional CAD-RADS showed superior value over anatomical CAD-RADS in guiding therapeutic decisions (AUC: 0.828 vs. 0.681, p < 0.001).
  • It demonstrated comparable performance to invasive FFR (AUC: 0.828 vs. 0.848, p = 0.253).
  • Functional CAD-RADS led to management plan revisions in 30.0% of patients (NRI = 0.369, p < 0.001) and was an independent predictor of 1-year outcomes (concordance index 0.795).

Conclusions:

  • The novel functional CAD-RADS, integrating FFR_CT, offers incremental value in therapeutic decision-making compared to anatomical CAD-RADS.
  • It possesses comparable power to anatomical CAD-RADS in predicting 1-year prognosis in a real-world setting.
  • This functional approach enhances risk stratification and guides treatment more effectively in CAD patients.
Abstract

Keywords:
Coronary Artery DiseaseCoronary artery diseaseCoronary computed tomography angiographyFractional flow reserveReporting and Data System

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