TY - JOUR
T1 - Prognostic Value of Coronary CTA in Stable Chest Pain
T2 - CAD-RADS, CAC, and Cardiovascular Events in PROMISE
AU - PROMISE Investigators
AU - Bittner, Daniel O.
AU - Mayrhofer, Thomas
AU - Budoff, Matt
AU - Szilveszter, Balint
AU - Foldyna, Borek
AU - Hallett, Travis R.
AU - Ivanov, Alexander
AU - Janjua, Sumbal
AU - Meyersohn, Nandini M.
AU - Staziaki, Pedro V.
AU - Achenbach, Stephan
AU - Ferencik, Maros
AU - Douglas, Pamela S.
AU - Hoffmann, Udo
AU - Lu, Michael T.
N1 - Publisher Copyright:
© 2020 American College of Cardiology Foundation
PY - 2020/7
Y1 - 2020/7
N2 - Objectives: The purpose of this study was to compare Coronary Artery Disease Reporting and Data System (CAD-RADS) to traditional stenosis categories and the coronary artery calcium score (CACS) for predicting cardiovascular events in patients with stable chest pain and suspected coronary artery disease (CAD). Background: The 2016 CAD-RADS has been established to standardize the reporting of CAD on coronary CT angiography (CTA). Methods: PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial participants’ CTAs were assessed by a central CT core laboratory for CACS, traditional stenosis-based categories, and modified CAD-RADS grade including high-risk coronary plaque (HRP) features. Traditional stenosis categories and CAD-RADS grade were compared for the prediction of the composite endpoint of death, myocardial infarction, or hospitalization for unstable angina over a median follow-up of 25 months. Incremental prognostic value over traditional risk factors and CACS was assessed. Results: In 3,840 eligible patients (mean age: 60.4 ± 8.2 years; 49% men), 3.0% (115) experienced events. CAD-RADS (concordance statistic [C-statistic] 0.747) had significantly higher discriminatory value than traditional stenosis-based assessments (C-statistic 0.698 to 0.717; all p for comparison ≤0.001). With no plaque (CAD-RADS 0) as the baseline, the hazard ratio (HR) for an event increased from 2.43 (95% confidence interval [CI]: 1.16 to 5.08) for CAD-RADS 1 to 21.84 (95% CI: 8.63 to 55.26) for CAD-RADS 4b and 5. In stepwise nested models, CAD-RADS added incremental prognostic value beyond ASCVD risk score and CACS (C-statistic 0.776 vs. 0.682; p < 0.001), and added incremental value persisted in all CACS strata. Conclusions: These data from a large representative contemporary cohort of patients undergoing coronary CTA for stable chest pain support the prognostic value of CAD-RADS as a standard reporting system for coronary CTA.
AB - Objectives: The purpose of this study was to compare Coronary Artery Disease Reporting and Data System (CAD-RADS) to traditional stenosis categories and the coronary artery calcium score (CACS) for predicting cardiovascular events in patients with stable chest pain and suspected coronary artery disease (CAD). Background: The 2016 CAD-RADS has been established to standardize the reporting of CAD on coronary CT angiography (CTA). Methods: PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial participants’ CTAs were assessed by a central CT core laboratory for CACS, traditional stenosis-based categories, and modified CAD-RADS grade including high-risk coronary plaque (HRP) features. Traditional stenosis categories and CAD-RADS grade were compared for the prediction of the composite endpoint of death, myocardial infarction, or hospitalization for unstable angina over a median follow-up of 25 months. Incremental prognostic value over traditional risk factors and CACS was assessed. Results: In 3,840 eligible patients (mean age: 60.4 ± 8.2 years; 49% men), 3.0% (115) experienced events. CAD-RADS (concordance statistic [C-statistic] 0.747) had significantly higher discriminatory value than traditional stenosis-based assessments (C-statistic 0.698 to 0.717; all p for comparison ≤0.001). With no plaque (CAD-RADS 0) as the baseline, the hazard ratio (HR) for an event increased from 2.43 (95% confidence interval [CI]: 1.16 to 5.08) for CAD-RADS 1 to 21.84 (95% CI: 8.63 to 55.26) for CAD-RADS 4b and 5. In stepwise nested models, CAD-RADS added incremental prognostic value beyond ASCVD risk score and CACS (C-statistic 0.776 vs. 0.682; p < 0.001), and added incremental value persisted in all CACS strata. Conclusions: These data from a large representative contemporary cohort of patients undergoing coronary CTA for stable chest pain support the prognostic value of CAD-RADS as a standard reporting system for coronary CTA.
KW - CAD-RADS
KW - coronary CT angiography
KW - coronary artery calcium
KW - coronary artery disease
KW - coronary stenosis
KW - high-risk plaque
KW - prognosis
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U2 - 10.1016/j.jcmg.2019.09.012
DO - 10.1016/j.jcmg.2019.09.012
M3 - Article
C2 - 31734213
AN - SCOPUS:85084228156
SN - 1936-878X
VL - 13
SP - 1534
EP - 1545
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 7
ER -