Department of Medicine, Cardiology Division, Brooke Army Medical Center, San Antonio, TX, USA.
Department of Flight Medicine, Little Rock Air Force Base, AR, USA.
J Cardiovasc Comput Tomogr. 2020 Sep-Oct;14(5):421-427. doi: 10.1016/j.jcct.2020.01.005. Epub 2020 Jan 22.
CAD-RADS was developed to standardize communication of per-patient maximal stenosis on coronary CT angiography (CCTA) and provide treatment recommendations and may impact primary prevention care and resource utilization. The authors sought to evaluate CAD-RADS adoption on preventive medical therapy and risk factor control amongst a mixed provider population.
Statins, aspirin (ASA), systolic blood pressure and, when available, lipid panel changes were abstracted for 1796 total patients undergoing CCTA in the 12 months before (non-standard reporting, NSR, cohort) and after adoption of the CAD-RADS reporting template. Only initiation of a medication in a treatment naïve patient, escalation from baseline dose, or transition to a higher potency was considered an escalation/initiation in lipid therapy.
The CAD-RADS reporting template was utilized in 83.7% (751/897) of CCTAs after the CAD-RADS adoption period. After adjusting for any coronary artery disease (CAD) on CCTA, statin initiation/escalation was more commonly observed in the CAD-RADS cohort (aOR 1.46; 95%CI 1.12-1.90, p = 0.005), driven by higher rates of new statin initiation (aOR 1.79; 95%CI 1.23-2.58, p = 0.002). This resulted in a higher observed rates of total cholesterol improvement in the CAD-RADS cohort (58% vs 49%, p = 0.016). New ASA initiation was similar between reporting templates after adjustment for CAD on CCTA (aOR 1.40; 95%CI 0.97-2.02, p = 0.069). The ordering provider's specialty (cardiology vs non-cardiology) did not significantly impact the observed differences in initiation/escalation of statins and ASA (pinteraction = NS).
Adoption of CAD-RADS reporting was associated with increased utilization of preventive medications, regardless of ordering provider specialty.
CAD-RADS 旨在标准化冠状动脉 CT 血管造影（CCTA）中每位患者最大狭窄程度的报告，并提供治疗建议，可能会影响初级预防保健和资源利用。作者旨在评估 CAD-RADS 在混合医疗服务提供者人群中对预防性药物治疗和危险因素控制的采用情况。
在 CAD-RADS 报告模板采用前后的 12 个月内，共对 1796 例接受 CCTA 的患者，提取他汀类药物、阿司匹林（ASA）、收缩压以及在可行情况下血脂谱变化的数据。仅在治疗初治患者时开始使用药物、从基线剂量增加剂量或转为更高强度的药物，才被认为是降脂治疗的增加/起始。
在 CAD-RADS 采用期间，83.7%（751/897）的 CCTA 使用了 CAD-RADS 报告模板。在校正任何 CCTA 上的冠状动脉疾病（CAD）后，在 CAD-RADS 组中，他汀类药物的起始/增加更为常见（优势比 1.46；95%置信区间 1.12-1.90，p=0.005），这主要是由于新起始他汀类药物的比例较高（优势比 1.79；95%置信区间 1.23-2.58，p=0.002）。这导致 CAD-RADS 组的总胆固醇改善率更高（58%比 49%，p=0.016）。在校正 CCTA 上的 CAD 后，两种报告模板中新 ASA 起始的比例相似（优势比 1.40；95%置信区间 0.97-2.02，p=0.069）。开方医生的专业（心脏病学与非心脏病学）并没有显著影响他汀类药物和 ASA 的起始/增加（p交互=NS）。
无论开方医生的专业如何，采用 CAD-RADS 报告都与预防性药物的使用增加相关。
