Background

The Coronary Artery Disease Reporting and Data System (CAD-RADS) was established in 2016 to standardize the reporting of coronary artery disease at coronary CT angiography (CCTA).

Purpose

To assess the prognostic value of CAD-RADS at CCTA for major adverse cardiovascular events (MACEs) in patients presenting to the emergency department with chest pain.

Materials and Methods

This multicenter retrospective observational cohort study was conducted at four qualifying university teaching hospitals. Patients presenting to the emergency department with acute chest pain underwent CCTA between January 2010 and December 2017. Multivariable Cox regression analysis was used to evaluate risk factors for MACEs, including clinical factors, coronary artery calcium score (CACS), and CAD-RADS categories. The prognostic value compared with clinical risk factors and CACS was also assessed.

Results

A total of 1492 patients were evaluated (mean age, 58 years ± 14 years [standard deviation]; 759 men). During a median follow-up period of 31.5 months, 103 of the 1492 patients (7%) experienced MACEs. Multivariable Cox regression analysis showed that a moderate to severe CACS was associated with MACEs after adjusting for clinical risk factors (hazard ratio [HR] range, 2.3–4.4; P value range, <.001 to <.01). CAD-RADS categories from 3 to 4 or 5 (HR range, 3.2–8.5; P < .001) and high-risk plaques (HR = 3.6, P < .001) were also associated with MACEs. The C statistics revealed that the CAD-RADS score improved risk stratification more than that using clinical risk factors alone or combined with CACS (C-index, 0.85 vs 0.63 [P < .001] and 0.76 [P < .01], respectively).

Conclusion

The Coronary Artery Disease Reporting and Data System classification had an incremental prognostic value compared with the coronary artery calcium score in the prediction of major adverse cardiovascular events in patients presenting to the emergency department with acute chest pain.

© RSNA, 2021

Online supplemental material is available for this article.

See also the editorial by Vliegenthart in this issue.

中文翻译：

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急性胸痛患者的冠状动脉 CT 血管造影 CAD-RADS 与冠状动脉钙评分

背景

冠状动脉疾病报告和数据系统（CAD-RADS）成立于2016年，旨在规范冠状动脉CT血管造影（CCTA）报告冠状动脉疾病。

目的

评估 CCTA 中 CAD-RADS 对因胸痛到急诊科就诊的患者的主要不良心血管事件 (MACE) 的预后价值。

材料和方法

这项多中心回顾性观察队列研究是在四家符合条件的大学教学医院进行的。2010 年 1 月至 2017 年 12 月期间因急性胸痛到急诊科就诊的患者接受了 CCTA。多变量 Cox 回归分析用于评估 MACE 的危险因素，包括临床因素、冠状动脉钙化评分 (CACS) 和 CAD-RADS 类别。还评估了与临床危险因素和 CACS 相比的预后价值。

结果

总共评估了 1492 名患者（平均年龄，58 岁 ± 14 岁 [标准差]；759 名男性）。在 31.5 个月的中位随访期间，1492 名患者中有 103 名 (7%) 经历了 MACE。多变量 Cox 回归分析显示，在调整临床危险因素后，中度至重度 CACS 与 MACE 相关（风险比 [HR] 范围，2.3-4.4；P值范围，<.001 至 <.01）。CAD-RADS 类别从 3 到 4 或 5（HR 范围，3.2-8.5；P < .001）和高风险斑块（HR = 3.6，P < .001）也与 MACE 相关。C 统计数据显示，CAD-RADS 评分比单独使用临床危险因素或与 CACS 结合使用更能改善风险分层（C 指数，0.85 比 0.63 [ P< .001] 和 0.76 [ P < .01]）。

结论

与冠状动脉钙化评分相比，冠状动脉疾病报告和数据系统分类在预测因急性胸痛到急诊科就诊的患者的主要不良心血管事件方面具有递增的预后价值。

©北美放射学会，2021

本文提供了在线补充材料。

另请参阅 Vliegenthart 在本期中的社论。