Prognostic significance of CAD-RADS for patients with suspected coronary artery disease: A systematic review and meta-analysis

Abstract

Abstract Background Coronary Artery Disease-Reporting and Data System (CAD-RADS) is a standardized reporting system that offers a structured method for interpreting and reporting results obtained through coronary computed tomography angiography. It has been deemed useful in the prognostication of patients with suspected coronary artery disease (CAD). Purpose The present meta-analysis sought to assess the prognostic value of CAD-RADS in individuals with suspected CAD. Materials and Methods We conducted a systematic search of the electronic databases of PubMed, Web of Science Core Collection, Cochrane advanced search, and EMBASE. A random-effects model was implemented to evaluate the pooled hazard ratio (HR) for each CAD-RADS category and area under the receiver operating characteristics curve for predicting major adverse cardiovascular events. Results Data from 37 596 coronary computed tomography angiography examinations from 13 studies were analyzed. During follow-up, 2,536 (6.7%) adverse events were observed. Pooled HRs for prediction of adverse events were significant for all CAD-RADS categories, with incremental increase in HRs with progressively higher categories. For prediction of all-cause mortality, all categories except CAD-RADS 1 showed significant HR compared with CAD-RADS 0. Combination of CAD-RADS to conventional clinical risk factors and CAC resulted in a high predictive capacity for adverse events (pooled area under the receiver operating characteristics curve: 0.82 ([95% confidence interval, 0.73-0.91]). Conclusion The CAD-RADS category imparts information on the CAD severity and shows incremental increase in HR for adverse events with progressively higher categories, especially beyond CAD-RADS4b.