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The prognostic value of preoperative CAD-RADS classification in patients undergoing isolated aortic valve surgery

Kitae Kim1, Byeong A Yoo1, Hyun Jung Koo2

  • 1Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.

The International Journal of Cardiovascular Imaging
|February 24, 2025
PubMed

Insights

Coronary Artery Disease Reporting and Data System (CAD-RADS) scores predict outcomes after aortic valve replacement (AVR). Higher CAD-RADS scores correlate with increased risk of death and major adverse cardiac and cerebrovascular events (MACCE) in AVR patients.

Area of Science:

  • Cardiology
  • Radiology
  • Cardiovascular Surgery

Background:

  • Aortic valve replacement (AVR) is a common procedure for aortic valve disease.
  • Concomitant coronary artery disease (CAD) can impact outcomes after AVR.
  • Accurate preoperative assessment of CAD severity is crucial for risk stratification.

Purpose of the Study:

  • To evaluate the association between preoperative coronary artery disease (CAD) severity, classified by CAD-RADS, and clinical outcomes in patients undergoing isolated AVR.
  • To determine if CAD-RADS scoring can predict all-cause death and MACCE in this patient population.

Main Methods:

  • Retrospective analysis of 897 patients who underwent isolated AVR with preoperative coronary computed tomography angiography (CCTA).
  • Patients were stratified by CAD-RADS scores (0-4).
  • Outcomes assessed included all-cause death and MACCE, analyzed using survival analysis and adjusted Cox regression.

Main Results:

  • CAD-RADS scores demonstrated a trend of increasing rates of all-cause death and MACCE with higher scores.
  • CAD-RADS score ≥3 was significantly associated with increased risk of all-cause death (HR 2.44) and MACCE (HR 1.79) after adjustment.
  • Patients with CAD-RADS ≥3 who received medical therapy alongside coronary angiography (CAG) showed improved survival.

Conclusions:

  • Preoperative CCTA and CAD-RADS assessment are valuable for identifying concomitant CAD and predicting long-term outcomes in patients undergoing isolated AVR.
  • Patients with CAD-RADS ≥3 require careful management, including consideration of medical therapy or intervention in conjunction with CAG.
  • CAD-RADS scoring can aid in personalized risk assessment and treatment planning for AVR patients.

Keywords:
Aortic valve diseaseCAD-RADS reporting systemCoronary angiographyCoronary artery diseaseCoronary computed tomography angiography

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