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European Radiology
Published in: European Radiology 8/2022

08-03-2022 | CT Angiography | Cardiac

Functional CAD-RADS using FFRCT on therapeutic management and prognosis in patients with coronary artery disease

Authors: Chun Xiang Tang, Hong Yan Qiao, Xiao Lei Zhang, Meng Di Jiang, U. Joseph Schoepf, Piotr Nikodem Rudziński, Dominic P. Giovagnoli, Meng Jie Lu, Jian Hua Li, Yi Ning Wang, Jia Yin Zhang, Yang Hou, Min Wen Zheng, Bo Zhang, Dai Min Zhang, Xiu Hua Hu, Lei Xu, Hui Liu, Guang Ming Lu, Long Jiang Zhang

Published in: European Radiology | Issue 8/2022

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Abstract

Objectives

To propose a novel functional Coronary Artery Disease–Reporting and Data System (CAD-RADS) category system integrated with coronary CT angiography (CCTA)–derived fractional flow reserve (FFRCT) and to validate its effect on therapeutic decision and prognosis in patients with coronary artery disease (CAD).

Methods

Firstly, we proposed a novel functional CAD-RADS and evaluated the performance of functional CAD-RADS for guiding treatment strategies with actual clinical treatment as a reference standard in a retrospective multicenter cohort with CCTA and invasive FFR performed in all patients (n = 466). Net reclassification improvement (NRI) of functional CAD-RADS over anatomical CAD-RADS was calculated. Secondly, the prognostic value of functional CAD-RADS in a prospective two-arm cohort (566 [FFRCT arm] vs. 567 [CCTA arm]) was calculated, after a 1-year follow-up, functional CAD-RADS in FFRCT arm (n = 513) and anatomical CAD-RADS in CCTA arm (n = 511) to determine patients at risk of adverse outcomes were compared with a Cox hazard proportional model.

Results

Functional CAD-RADS demonstrated superior value over anatomical CAD-RADS (AUC: 0.828 vs. 0.681, p < 0.001) and comparable performance to FFR (AUC: 0.828 vs. 0.848, p = 0.253) in guiding therapeutic decisions. Functional CAD-RADS resulted in the revision of management plan as determined by anatomical CAD-RADS in 30.0% of patients (n = 140) (NRI = 0.369, p < 0.001). Functional CAD-RADS was an independent predictor for 1-year outcomes with indexes of concordance of 0.795 and the corresponding value was 0.751 in anatomical CAD-RADS.

Conclusion

The novel functional CAD-RADS gained incremental value in guiding therapeutic decision-making compared with anatomical CAD-RADS and comparable power in 1-year prognosis with anatomical CAD-RADS in a real-world scenario.

Key Points

• The novel functional CAD-RADS category system with FFRCT integrated into the anatomical CAD-RADS categories was originally proposed.
• The novel functional CAD-RADS category system was validated superior value over anatomical CAD-RADS (AUC: 0.828 vs. 0.681, p < 0.001) in guiding therapeutic decisions and revised management plan in 30.0% of patients as determined by anatomical CAD-RADS (net reclassification improvement index = 0.369, p < 0.001).
• Functional CAD-RADS was an independent predictor with an index of concordance of 0.795 and 0.751 in anatomical CAD-RADS for 1-year prognosis of adverse outcomes.
Appendix
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Metadata
Title
Functional CAD-RADS using FFRCT on therapeutic management and prognosis in patients with coronary artery disease
Authors
Chun Xiang Tang
Hong Yan Qiao
Xiao Lei Zhang
Meng Di Jiang
U. Joseph Schoepf
Piotr Nikodem Rudziński
Dominic P. Giovagnoli
Meng Jie Lu
Jian Hua Li
Yi Ning Wang
Jia Yin Zhang
Yang Hou
Min Wen Zheng
Bo Zhang
Dai Min Zhang
Xiu Hua Hu
Lei Xu
Hui Liu
Guang Ming Lu
Long Jiang Zhang
Publication date
08-03-2022
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 8/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-022-08618-5

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