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Updated: Aug 6, 2026

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
10:28

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function

Published on: March 15, 2022

Clinical Management and Outcomes Based on Functional Coronary Artery Disease Reporting and Data System Compared With

Chun Xiang Tang1, Fan Zhou1, Hong Yan Qiao2

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

Journal of the American College of Radiology : JACR
|July 23, 2026
PubMed

Insights

Functional Coronary Artery Disease Reporting and Data System (CAD-RADS), integrating CT-FFR, offers superior 5-year prognostic value for stable coronary artery disease (CAD) compared to anatomical CAD-RADS. This improves patient management and treatment algorithms.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Diagnostic Tools

Background:

  • Anatomical Coronary Artery Disease Reporting and Data System (CAD-RADS) is standard for coronary CT angiography (CCTA) but lacks specificity for ischemia.
  • Predicting lesion-specific ischemia is crucial for effective management of coronary artery disease (CAD).

Purpose of the Study:

  • To evaluate the prognostic value of a novel functional CAD-RADS, incorporating CT-derived fractional flow reserve (CT-FFR).
  • To compare the 5-year predictive performance of functional CAD-RADS against anatomical CAD-RADS in stable CAD patients.

Main Methods:

  • A prospective cohort study of 1096 patients with stable CAD (25%-80% stenosis) undergoing CCTA.
  • Primary endpoint was major adverse cardiac events (MACE); management decision appropriateness was assessed.
  • Statistical analysis included Kaplan-Meier, Cox models, integrated discrimination improvement (IDI), and net reclassification improvement (NRI).

Main Results:

  • Functional CAD-RADS demonstrated superior prediction of MACE compared to anatomical CAD-RADS (C-index 0.780 vs. 0.723, p=0.035).
  • Functional CAD-RADS showed improved discrimination (IDI: 0.053, p=0.008) and a lower rate of inappropriate management decisions (9.9% vs. 11.0%).
  • Both systems predicted MACE (p < 0.001), with functional CAD-RADS offering better prognostic insights.

Conclusions:

  • Functional CAD-RADS provides enhanced predictive power for moderate-term outcomes in stable CAD patients.
  • This suggests functional CAD-RADS has significant clinical utility for guiding patient management and treatment strategies.
  • The findings are particularly relevant for patients with intermediate coronary artery stenosis.
Abstract

Keywords:
CT angiographyCoronary Artery Disease Reporting and Data Systemcoronary artery diseasefractional flow reserve

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