Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA.
Eur Radiol. 2022 Aug;32(8):5210-5221. doi: 10.1007/s00330-022-08618-5. Epub 2022 Mar 8.
To propose a novel functional Coronary Artery Disease-Reporting and Data System (CAD-RADS) category system integrated with coronary CT angiography (CCTA)-derived fractional flow reserve (FFR) and to validate its effect on therapeutic decision and prognosis in patients with coronary artery disease (CAD).
Firstly, we proposed a novel functional CAD-RADS and evaluated the performance of functional CAD-RADS for guiding treatment strategies with actual clinical treatment as a reference standard in a retrospective multicenter cohort with CCTA and invasive FFR performed in all patients (n = 466). Net reclassification improvement (NRI) of functional CAD-RADS over anatomical CAD-RADS was calculated. Secondly, the prognostic value of functional CAD-RADS in a prospective two-arm cohort (566 [FFR arm] vs. 567 [CCTA arm]) was calculated, after a 1-year follow-up, functional CAD-RADS in FFR arm (n = 513) and anatomical CAD-RADS in CCTA arm (n = 511) to determine patients at risk of adverse outcomes were compared with a Cox hazard proportional model.
Functional CAD-RADS demonstrated superior value over anatomical CAD-RADS (AUC: 0.828 vs. 0.681, p < 0.001) and comparable performance to FFR (AUC: 0.828 vs. 0.848, p = 0.253) in guiding therapeutic decisions. Functional CAD-RADS resulted in the revision of management plan as determined by anatomical CAD-RADS in 30.0% of patients (n = 140) (NRI = 0.369, p < 0.001). Functional CAD-RADS was an independent predictor for 1-year outcomes with indexes of concordance of 0.795 and the corresponding value was 0.751 in anatomical CAD-RADS.
The novel functional CAD-RADS gained incremental value in guiding therapeutic decision-making compared with anatomical CAD-RADS and comparable power in 1-year prognosis with anatomical CAD-RADS in a real-world scenario.
• The novel functional CAD-RADS category system with FFR integrated into the anatomical CAD-RADS categories was originally proposed. • The novel functional CAD-RADS category system was validated superior value over anatomical CAD-RADS (AUC: 0.828 vs. 0.681, p < 0.001) in guiding therapeutic decisions and revised management plan in 30.0% of patients as determined by anatomical CAD-RADS (net reclassification improvement index = 0.369, p < 0.001). • Functional CAD-RADS was an independent predictor with an index of concordance of 0.795 and 0.751 in anatomical CAD-RADS for 1-year prognosis of adverse outcomes.
提出一种新的功能性冠心病报告和数据系统（CAD-RADS）类别系统，该系统与冠状动脉 CT 血管造影（CCTA）衍生的血流储备分数（FFR）相结合，并验证其在冠心病患者治疗决策和预后中的效果。
首先，我们提出了一种新的功能性 CAD-RADS，并在回顾性多中心队列中评估了功能性 CAD-RADS 指导治疗策略的性能，该队列在所有患者中均进行了 CCTA 和有创 FFR（n=466）。计算功能性 CAD-RADS 相对于解剖学 CAD-RADS 的净重新分类改善（NRI）。其次，在前瞻性双臂队列（566[FFR 臂]与 567[CCTA 臂]）中计算了功能性 CAD-RADS 的预后价值，在 1 年随访后，FFR 臂中的功能性 CAD-RADS（n=513）和 CCTA 臂中的解剖学 CAD-RADS（n=511）比较 Cox 风险比例模型确定不良结局风险患者。
功能性 CAD-RADS 在指导治疗决策方面优于解剖学 CAD-RADS（AUC：0.828 对 0.681，p<0.001），与 FFR 相当（AUC：0.828 对 0.848，p=0.253）。功能性 CAD-RADS 导致 30.0%的患者（n=140）的管理计划修订，与解剖学 CAD-RADS 相比，NRI 为 0.369（p<0.001）。功能性 CAD-RADS 是 1 年预后的独立预测因子，其一致性指数为 0.795，解剖学 CAD-RADS 的相应值为 0.751。
在真实世界环境中，与解剖学 CAD-RADS 相比，新的功能性 CAD-RADS 在指导治疗决策方面具有附加价值，在 1 年预后方面与解剖学 CAD-RADS 具有相当的效果。
提出了一种新的功能性 CAD-RADS 类别系统，该系统将 FFR 与解剖学 CAD-RADS 类别相结合。
新的功能性 CAD-RADS 类别系统在指导治疗决策方面优于解剖学 CAD-RADS（AUC：0.828 对 0.681，p<0.001），并通过解剖学 CAD-RADS 确定的 30.0%的患者修订了管理计划（净重新分类改善指数=0.369，p<0.001）。
功能性 CAD-RADS 是独立预测因子，1 年不良预后的一致性指数为 0.795，解剖学 CAD-RADS 为 0.751。
