CAD-RADS a ‘big step in the right direction’ toward improving outcomes for acute chest pain

The Coronary Artery Disease Reporting and Data System can better predict major adverse cardiovascular events in patients with chest pain compared to coronary artery calcium scoring, according to a prospective study published Tuesday.

CAD-RADS was first introduced in 2016 to standardize coronary artery disease reporting during coronary CT angiography exams, experts explained in Radiology. Prior research has proven the system’s superiority over CAC scoring for stable chest pain, but there have been fewer investigations into its accuracy for predicting major adverse cardio events in those with acute pain.

With this in mind, radiologists out of South Korea evaluated nearly 1,500 patients who underwent CCTA exams for acute chest pain across four teaching hospital emergency departments. 

Over nearly seven years, they found that CAD-RADS scoring improved risk stratification more than clinical risk factors alone or when combined with CAC scoring.

“The Coronary Artery Disease Reporting and Data System classification had an incremental prognostic value compared with the coronary artery calcium score in the prediction of major adverse cardiovascular events in patients presenting to the emergency department with acute chest pain,” Ji Won Lee, with the department of radiology at Pusan National University Hospital, and colleagues wrote.

Furthermore, higher CAD-RADS scores and the presence of high-risk plaques were independent predictors of major cardiovascular events.

Rozemarijn Vliegenthart, MD, PhD, a radiologist at the University Medical Center Groningen in the Netherlands, said to her knowledge, this study is the first to analyze the prognostic value of CAD-RADS in individuals with acute chest pain. Vliegenthart shared her review of the study in an editorial published Tuesday.

She noted this investigation adds to growing evidence suggesting CAD-RADS will help radiologists more clearly communicate CT-based findings with referring physicians.

“CAD-RADS helps to standardize quality of care and, moreover, may improve the outcome in patients with acute chest pain across emergency departments,” Vliegenthart added. “Although it may still be, as to be expected in such a study, a preliminary expectation, in my opinion, it is a big step in the right direction.”

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