From the Departments of Cardiology, Radiology (H.Z., S.L., Y.G.), and Cardiovascular Surgery (Z.G.), Tianjin University Chest Hospital, No. 261 Taierzhuang South Road, Tianjin 300350, China (J. Zhou, C. Li, C. Liu, J. Zhao, Y.L., C.X., M.W., C.W., S.W., E.Z., H.C.); Clinical School of Thoracic, Tianjin Medical University, Tianjin, China (C. Liu, S.W.); Senior Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, Beijing, China (J.Y., D.S., Y.C.); School of Electrical and Information Engineering, Tianjin University, Tianjin, China (Y. Hou, P.Z.); Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (Y.T.); Department of Clinical Epidemiology and Evidence-Based Medicine, Friendship Hospital, Capital Medical University, Beijing, China (H.W.); and Department of Cardiology, Peking University First Hospital, Beijing, China (Y. Huo).
Radiology. 2023 Jun;307(5):e222965. doi: 10.1148/radiol.222965.
Background Coronary Artery Disease Reporting and Data System (CAD-RADS) was developed to standardize and optimize disease management in patients after coronary CT angiography (CCTA), but the impact of CAD-RADS management recommendations on clinical outcomes remains unclear. Purpose To retrospectively assess the association between the appropriateness of post-CCTA management according to CAD-RADS version 2.0 and clinical outcomes. Materials and Methods From January 2016 to January 2018, consecutive participants with stable chest pain referred for CCTA were prospectively included in a Chinese registry and followed for 4 years. Retrospectively, CAD-RADS 2.0 classification and the appropriateness of post-CCTA management were determined. Propensity score matching (PSM) was used to adjust for confounding variables. Hazard ratios (HRs) for a major adverse cardiovascular event (MACE), relative risks for invasive coronary angiography (ICA), and the corresponding number needed to treat were estimated. Results Of the 14 232 included participants (mean age, 61 years ± 13 [SD]; 8852 male), 2330, 2756, and 2614 were retrospectively categorized in CAD-RADS 1, 2, and 3, respectively. Only 26% of participants with CAD-RADS 1-2 disease and 20% with CAD-RADS 3 received appropriate post-CCTA management. After PSM, appropriate post-CCTA management was associated with lower risk of MACEs (HR, 0.34; 95% CI: 0.22, 0.51; < .001), corresponding to a number needed to treat of 21 in CAD-RADS 1-2 but not CAD-RADS 3 (HR, 0.86; 95% CI: 0.49, 1.85; = .42). Appropriate post-CCTA management was associated with decreased use of ICA in CAD-RADS 1-2 (relative risk, 0.40; 95% CI: 0.29, 0.55; < .001) and 3 (relative risk, 0.33; 95% CI: 0.28, 0.39; < .001), resulting in a number needed to treat of 14 and 2, respectively. Conclusion In this retrospective secondary analysis, appropriate disease management after CCTA according to CAD-RADS 2.0 was associated with lower risk of MACEs and more prudent use of ICA. ClinicalTrials.gov registration no. NCT04691037 © RSNA, 2023 See also the editorial by Leipsic and Tzimas in this issue.
冠状动脉疾病报告和数据系统（CAD-RADS）旨在标准化和优化冠状动脉 CT 血管造影（CCTA）后患者的疾病管理，但 CAD-RADS 管理建议对临床结果的影响仍不清楚。目的：回顾性评估根据 CAD-RADS 版本 2.0 进行的 CCTA 后管理的适当性与临床结果之间的关系。材料与方法：从 2016 年 1 月至 2018 年 1 月，连续纳入因稳定型胸痛而行 CCTA 的患者，前瞻性纳入中国登记处，并随访 4 年。回顾性地，确定了 CAD-RADS 2.0 分类和 CCTA 后管理的适当性。采用倾向评分匹配（PSM）来调整混杂变量。估计主要不良心血管事件（MACE）的风险比（HR）、经皮冠状动脉介入治疗（ICA）的相对风险和相应的治疗人数。结果：在纳入的 14232 例患者（平均年龄，61 岁±13[标准差]；8852 例男性）中，分别有 2330 例、2756 例和 2614 例患者被回顾性分类为 CAD-RADS 1、2 和 3。只有 26%的 CAD-RADS 1-2 疾病患者和 20%的 CAD-RADS 3 疾病患者接受了适当的 CCTA 后管理。PSM 后，适当的 CCTA 后管理与较低的 MACE 风险相关（HR，0.34；95%CI：0.22，0.51； <.001），相应的治疗人数为 21 例在 CAD-RADS 1-2 中，但不在 CAD-RADS 3 中（HR，0.86；95%CI：0.49，1.85； =.42）。适当的 CCTA 后管理与 CAD-RADS 1-2（相对风险，0.40；95%CI：0.29，0.55； <.001）和 3（相对风险，0.33；95%CI：0.28，0.39； <.001）中 ICA 的使用减少相关，分别导致治疗人数需要 14 和 2。结论：在这项回顾性二次分析中，根据 CAD-RADS 2.0 进行的 CCTA 后适当的疾病管理与较低的 MACE 风险和更谨慎的 ICA 使用相关。ClinicalTrials.gov 注册号：NCT04691037©RSNA，2023 请参阅本期 Leipsic 和 Tzimas 的社论。
