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Prognostic Value of Coronary CTA in Stable Chest Pain: CAD-RADS, CAC, and Cardiovascular Events in PROMISE.

Publication ,  Journal Article
Bittner, DO; Mayrhofer, T; Budoff, M; Szilveszter, B; Foldyna, B; Hallett, TR; Ivanov, A; Janjua, S; Meyersohn, NM; Staziaki, PV; Achenbach, S ...
Published in: JACC Cardiovasc Imaging
July 2020

OBJECTIVES: The purpose of this study was to compare Coronary Artery Disease Reporting and Data System (CAD-RADS) to traditional stenosis categories and the coronary artery calcium score (CACS) for predicting cardiovascular events in patients with stable chest pain and suspected coronary artery disease (CAD). BACKGROUND: The 2016 CAD-RADS has been established to standardize the reporting of CAD on coronary CT angiography (CTA). METHODS: PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial participants' CTAs were assessed by a central CT core laboratory for CACS, traditional stenosis-based categories, and modified CAD-RADS grade including high-risk coronary plaque (HRP) features. Traditional stenosis categories and CAD-RADS grade were compared for the prediction of the composite endpoint of death, myocardial infarction, or hospitalization for unstable angina over a median follow-up of 25 months. Incremental prognostic value over traditional risk factors and CACS was assessed. RESULTS: In 3,840 eligible patients (mean age: 60.4 ± 8.2 years; 49% men), 3.0% (115) experienced events. CAD-RADS (concordance statistic [C-statistic] 0.747) had significantly higher discriminatory value than traditional stenosis-based assessments (C-statistic 0.698 to 0.717; all p for comparison ≤0.001). With no plaque (CAD-RADS 0) as the baseline, the hazard ratio (HR) for an event increased from 2.43 (95% confidence interval [CI]: 1.16 to 5.08) for CAD-RADS 1 to 21.84 (95% CI: 8.63 to 55.26) for CAD-RADS 4b and 5. In stepwise nested models, CAD-RADS added incremental prognostic value beyond ASCVD risk score and CACS (C-statistic 0.776 vs. 0.682; p < 0.001), and added incremental value persisted in all CACS strata. CONCLUSIONS: These data from a large representative contemporary cohort of patients undergoing coronary CTA for stable chest pain support the prognostic value of CAD-RADS as a standard reporting system for coronary CTA.

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Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

July 2020

Volume

13

Issue

7

Start / End Page

1534 / 1545

Location

United States

Related Subject Headings

  • United States
  • Risk Assessment
  • Prospective Studies
  • Prognosis
  • Predictive Value of Tests
  • Minority Groups
  • Middle Aged
  • Male
  • Humans
  • Female
 

Citation

APA
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ICMJE
MLA
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Bittner, D. O., Mayrhofer, T., Budoff, M., Szilveszter, B., Foldyna, B., Hallett, T. R., … PROMISE Investigators, . (2020). Prognostic Value of Coronary CTA in Stable Chest Pain: CAD-RADS, CAC, and Cardiovascular Events in PROMISE. JACC Cardiovasc Imaging, 13(7), 1534–1545. https://doi.org/10.1016/j.jcmg.2019.09.012
Bittner, Daniel O., Thomas Mayrhofer, Matt Budoff, Balint Szilveszter, Borek Foldyna, Travis R. Hallett, Alexander Ivanov, et al. “Prognostic Value of Coronary CTA in Stable Chest Pain: CAD-RADS, CAC, and Cardiovascular Events in PROMISE.JACC Cardiovasc Imaging 13, no. 7 (July 2020): 1534–45. https://doi.org/10.1016/j.jcmg.2019.09.012.
Bittner DO, Mayrhofer T, Budoff M, Szilveszter B, Foldyna B, Hallett TR, et al. Prognostic Value of Coronary CTA in Stable Chest Pain: CAD-RADS, CAC, and Cardiovascular Events in PROMISE. JACC Cardiovasc Imaging. 2020 Jul;13(7):1534–45.
Bittner, Daniel O., et al. “Prognostic Value of Coronary CTA in Stable Chest Pain: CAD-RADS, CAC, and Cardiovascular Events in PROMISE.JACC Cardiovasc Imaging, vol. 13, no. 7, July 2020, pp. 1534–45. Pubmed, doi:10.1016/j.jcmg.2019.09.012.
Bittner DO, Mayrhofer T, Budoff M, Szilveszter B, Foldyna B, Hallett TR, Ivanov A, Janjua S, Meyersohn NM, Staziaki PV, Achenbach S, Ferencik M, Douglas PS, Hoffmann U, Lu MT, PROMISE Investigators. Prognostic Value of Coronary CTA in Stable Chest Pain: CAD-RADS, CAC, and Cardiovascular Events in PROMISE. JACC Cardiovasc Imaging. 2020 Jul;13(7):1534–1545.
Journal cover image

Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

July 2020

Volume

13

Issue

7

Start / End Page

1534 / 1545

Location

United States

Related Subject Headings

  • United States
  • Risk Assessment
  • Prospective Studies
  • Prognosis
  • Predictive Value of Tests
  • Minority Groups
  • Middle Aged
  • Male
  • Humans
  • Female