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Association between Coronary Artery Disease Reporting and Data System-recommended Post-Coronary CT Angiography
Jia Zhou1, Chunjie Li1, Hong Zhang1
1From the Departments of Cardiology, Radiology (H.Z., S.L., Y.G.), and Cardiovascular Surgery (Z.G.), Tianjin University Chest Hospital, No. 261 Taierzhuang South Road, Tianjin 300350, China (J. Zhou, C. Li, C. Liu, J. Zhao, Y.L., C.X., M.W., C.W., S.W., E.Z., H.C.); Clinical School of Thoracic, Tianjin Medical University, Tianjin, China (C. Liu, S.W.); Senior Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, Beijing, China (J.Y., D.S., Y.C.); School of Electrical and Information Engineering, Tianjin University, Tianjin, China (Y. Hou, P.Z.); Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (Y.T.); Department of Clinical Epidemiology and Evidence-Based Medicine, Friendship Hospital, Capital Medical University, Beijing, China (H.W.); and Department of Cardiology, Peking University First Hospital, Beijing, China (Y. Huo).
Insights
Appropriate management following coronary CT angiography (CCTA) based on Coronary Artery Disease Reporting and Data System (CAD-RADS) guidelines reduces major adverse cardiovascular events (MACE) and invasive coronary angiography use.
Area of Science:
- Cardiology
- Radiology
- Medical Informatics
Background:
- Coronary Artery Disease Reporting and Data System (CAD-RADS) aims to standardize post-coronary CT angiography (CCTA) management.
- The clinical impact of CAD-RADS management recommendations on patient outcomes requires further investigation.
Purpose of the Study:
- To retrospectively evaluate the association between appropriate post-CCTA management, guided by CAD-RADS version 2.0, and clinical outcomes.
- To assess the impact of CAD-RADS adherence on major adverse cardiovascular events (MACE) and invasive coronary angiography (ICA) utilization.
Main Methods:
- A retrospective analysis of 14,232 patients from a prospective Chinese registry (2016-2018) with 4-year follow-up.
- CAD-RADS 2.0 classification and management appropriateness were determined; propensity score matching (PSM) adjusted for confounders.
- Hazard ratios (HRs) for MACE and relative risks (RR) for ICA were calculated, including number needed to treat (NNT).
Main Results:
- Only 26% of CAD-RADS 1-2 and 20% of CAD-RADS 3 patients received appropriate management.
- Appropriate management significantly lowered MACE risk in CAD-RADS 1-2 (HR=0.34) but not CAD-RADS 3 (HR=0.86) after PSM.
- Appropriate management decreased ICA use in CAD-RADS 1-2 (RR=0.40) and CAD-RADS 3 (RR=0.33), with NNT of 14 and 2, respectively.
Conclusions:
- Adherence to appropriate post-CCTA management, as defined by CAD-RADS 2.0, is associated with improved clinical outcomes.
- Appropriate management leads to a significant reduction in MACE and a more judicious use of invasive coronary angiography.
- These findings underscore the clinical utility of CAD-RADS in optimizing patient care pathways after CCTA.
Abstract:
Background Coronary Artery Disease Reporting and Data System (CAD-RADS) was developed to standardize and optimize disease management in patients after coronary CT angiography (CCTA), but the impact of CAD-RADS management recommendations on clinical outcomes remains unclear. Purpose To retrospectively assess the association between the appropriateness of post-CCTA management according to CAD-RADS version 2.0 and clinical outcomes. Materials and Methods From January 2016 to January 2018, consecutive participants with stable chest pain referred for CCTA were prospectively included in a Chinese registry and followed for 4 years. Retrospectively, CAD-RADS 2.0 classification and the appropriateness of post-CCTA management were determined. Propensity score matching (PSM) was used to adjust for confounding variables. Hazard ratios (HRs) for a major adverse cardiovascular event (MACE), relative risks for invasive coronary angiography (ICA), and the corresponding number needed to treat were estimated. Results Of the 14 232 included participants (mean age, 61 years ± 13 [SD]; 8852 male), 2330, 2756, and 2614 were retrospectively categorized in CAD-RADS 1, 2, and 3, respectively. Only 26% of participants with CAD-RADS 1-2 disease and 20% with CAD-RADS 3 received appropriate post-CCTA management. After PSM, appropriate post-CCTA management was associated with lower risk of MACEs (HR, 0.34; 95% CI: 0.22, 0.51; P < .001), corresponding to a number needed to treat of 21 in CAD-RADS 1-2 but not CAD-RADS 3 (HR, 0.86; 95% CI: 0.49, 1.85; P = .42). Appropriate post-CCTA management was associated with decreased use of ICA in CAD-RADS 1-2 (relative risk, 0.40; 95% CI: 0.29, 0.55; P < .001) and 3 (relative risk, 0.33; 95% CI: 0.28, 0.39; P < .001), resulting in a number needed to treat of 14 and 2, respectively. Conclusion In this retrospective secondary analysis, appropriate disease management after CCTA according to CAD-RADS 2.0 was associated with lower risk of MACEs and more prudent use of ICA. ClinicalTrials.gov registration no. NCT04691037 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Leipsic and Tzimas in this issue.
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