Aims We wished to assess whether different clinical definitions of coronary artery disease (CAD) [segment stenosis and involvement score (SSS, SIS), Coronary Artery Disease—Reporting and Data System (CAD-RADS)] affect which patients are considered to progress and which risk factors affect progression. Methods and results We enrolled 115 subsequent patients (60.1 ± 9.6 years, 27% female) who underwent serial coronary computed tomography angiography (CTA) imaging with >1year between the two examinations. CAD was described using SSS, SIS, and CAD-RADS. Linear mixed models were used to investigate the effects of risk factors on the overall amount of CAD and the effect on annual progression rate of different definitions. Coronary plaque burdens were SSS 4.63 ± 4.06 vs. 5.67 ± 5.10, P < 0.001; SIS 3.43 ± 2.53 vs. 3.89 ± 2.65, P < 0.001; CAD-RADS 0:8.7% vs. 0.0% 1:44.3% vs. 40.9%, 2:34.8% vs. 40.9%, 3:7.0% vs. 9.6% 4:3.5% vs. 6.1% 5:1.7% vs. 2.6%, P < 0.001, at baseline and follow-up, respectively. Overall, 53.0%, 29.6%, and 28.7% of patients progressed over time based on SSS, SIS, and CAD-RADS, respectively. Of the patients who progressed based on SSS, only 54% showed changes in CAD-RADS. Smoking and diabetes increased the annual progression rate of SSS by 0.37/year and 0.38/year, respectively (both P < 0.05). Furthermore, each year increase in age raised SSS by 0.12 [confidence interval (CI) 0.05–0.20, P = 0.001] and SIS 0.10 (CI 0.06–0.15, P < 0.001), while female sex was associated with 2.86 lower SSS (CI −4.52 to −1.20, P < 0.001) and 1.68 SIS values (CI −2.65 to −0.77, P = 0.001). Conclusion CAD-RADS could not capture the progression of CAD in almost half of patients with serial CTA. Differences in CAD definitions may lead to significant differences in patients who are considered to progress, and which risk factors are considered to influence progression.

中文翻译：

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CAD-RADS 可能低估了连续 CT 血管造影检测到的冠状动脉斑块进展

目的 我们希望评估冠状动脉疾病 (CAD) [节段狭窄和受累评分 (SSS, SIS)、冠状动脉疾病报告和数据系统 (CAD-RADS)] 的不同临床定义是否会影响哪些患者被认为进展和恶化哪些风险因素会影响进展。方法和结果 我们招募了 115 名后续患者（60.1 ± 9.6 岁，27% 为女性），他们接受了连续冠状动脉计算机断层扫描血管造影 (CTA) 成像，两次检查之间的间隔时间超过 1 年。使用 SSS、SIS 和 CAD-RADS 描述 CAD。采用线性混合模型研究危险因素对冠心病总量的影响以及不同定义对年进展率的影响。冠状动脉斑块负荷为 SSS 4.63 ± 4.06 对比 5.67 ± 5.10，P < 0.001; SIS 3.43 ± 2.53 对比 3.89 ± 2.65，P < 0。001; CAD-RADS 0:8.7% vs. 0.0% 1:44.3% vs. 40.9%, 2:34.8% vs. 40.9%, 3:7.0% vs. 9.6% 4:3.5% vs. 6.1% 5:1.7% vs. . 2.6%, P < 基线和随访时分别为 0.001。总体而言，根据 SSS、SIS 和 CAD-RADS，随着时间的推移，分别有 53.0%、29.6% 和 28.7% 的患者出现进展。在基于 SSS 进展的患者中，只有 54% 显示 CAD-RADS 发生变化。吸烟和糖尿病使 SSS 的年进展率分别增加 0.37 次/年和 0.38 次/年（均 P < 0.05）。此外，随着年龄的增长，SSS 每年增加 0.12 [置信区间 (CI) 0.05–0.20，P = 0.001]，SIS 增加 0.10（CI 0.06–0.15，P < 0.001），而女性与 SSS 降低 2.86 相关（ CI -4.52 至 -1.20，P < 0.001）和 1.68 SIS 值（CI -2.65 至 -0.77，P = 0.001）。结论 CAD-RADS 无法捕捉到近半数连续 CTA 患者的 CAD 进展。CAD 定义的差异可能导致被认为进展的患者以及被认为影响进展的风险因素的显着差异。