Huang Zengfa, Yang Yang, Wang Zheng, Hu Yunting, Cao Beibei, Li Mei, Du Xinyu, Wang Xi, Li Zuoqin, Wang Wanpeng, Ding Yi, Xiao Jianwei, Hu Yun, Wang Xiang
Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430014, China.
Department of Community Health, Hanyang District Center For Disease Control and Prevention, Wuhan, Hubei, 430050, China.
Heliyon. 2023 May 4;9(5):e15988. doi: 10.1016/j.heliyon.2023.e15988. eCollection 2023 May.
The aim of the present study was to investigate the prognostic value of the novel coronary artery disease reporting and data system (CAD-RADS) 2.0 compared with CAD-RADS 1.0 in patients with suspectedcoronary artery disease (CAD) evaluated by convolutional neural networks (CNN) based coronary computed tomography angiography (CCTA).
A total of 1796 consecutive inpatients with suspected CAD were evaluated by CCTA for CAD-RADS 1.0 and CAD-RADS 2.0 classifications. Kaplan-Meier and multivariate Cox models were used to estimate major adverse cardiovascular events (MACE) inclusive of all-cause mortality or myocardial infarction (MI). The C-statistic was used to assess the discriminatory ability of the two classifications.
In total, 94 (5.2%) MACE occurred over the median follow-up of 45.25 months (interquartile range 43.53-46.63 months). The annualized MACE rate was 0.014 (: 0.011-0.017). Kaplan-Meier survival curves indicated that the CAD-RADS classification, segment involvement score (SIS) grade, and Computed Tomography Fractional Flow Reserve (CT-FFR) classification were all significantly associated with the increase in the cumulative MACE (all < 0.001). CAD-RADS classification, SIS grade, and CT-FFR classification were significantly associated with endpoint in univariate and multivariate Cox analysis. CAD-RADS 2.0 showed a further incremental increase in the prognostic value in predicting MACE (c-statistic 0.702, : 0.641-0.763, = 0.047), compared with CAD-RADS 1.0.
The novel CAD-RADS 2.0 evaluated by CNN-based CCTA showed higher prognostic value of MACE than CAD-RADS 1.0 in patients with suspected CAD.
本研究旨在探讨新型冠状动脉疾病报告和数据系统（CAD-RADS）2.0与CAD-RADS 1.0相比，在基于卷积神经网络（CNN）的冠状动脉计算机断层扫描血管造影（CCTA）评估的疑似冠状动脉疾病（CAD）患者中的预后价值。
共有1796例连续的疑似CAD住院患者接受了CCTA检查，以进行CAD-RADS 1.0和CAD-RADS 2.0分类。采用Kaplan-Meier法和多变量Cox模型来估计包括全因死亡率或心肌梗死（MI）在内的主要不良心血管事件（MACE）。C统计量用于评估两种分类的鉴别能力。
在中位随访45.25个月（四分位间距43.53 - 46.63个月）期间，共发生94例（5.2%）MACE。年化MACE发生率为0.014（95%置信区间：0.011 - 0.017）。Kaplan-Meier生存曲线表明，CAD-RADS分类、节段累及评分（SIS）等级和计算机断层扫描血流储备分数（CT-FFR）分类均与累积MACE的增加显著相关（均P < 0.001）。在单变量和多变量Cox分析中，CAD-RADS分类、SIS等级和CT-FFR分类均与终点显著相关。与CAD-RADS 1.0相比，CAD-RADS 2.0在预测MACE方面的预后价值进一步增加（C统计量0.702，95%置信区间：0.641 - 0.763，P = 0.047）。
在疑似CAD患者中，基于CNN的CCTA评估的新型CAD-RADS 2.0显示出比CAD-RADS 1.0更高的MACE预后价值。
