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Prognostic value of coronary artery disease-reporting and data system (CAD-RADS) score for cardiovascular events in ischemic stroke

  • Kyungsun Nam
    Affiliations
    Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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  • Jin Hur
    Correspondence
    Corresponding author. Department of Radiology and Research Institute of Radiological Science Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea.
    Affiliations
    Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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  • Kyunghwa Han
    Affiliations
    Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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  • Dong Jin Im
    Affiliations
    Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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  • Young Joo Suh
    Affiliations
    Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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  • Yoo Jin Hong
    Affiliations
    Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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  • Hye-Jeong Lee
    Affiliations
    Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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  • Young Jin Kim
    Affiliations
    Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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  • Byoung Wook Choi
    Affiliations
    Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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      Highlights

      • Ischemic stroke patients have a substantial prevalence of coronary artery disease.
      • CAD-RADS has prognostic value for future MACEs in stroke patients.
      • CAD-RADS provides additional risk-prediction over CACS.

      Abstract

      Background and aims

      The coronary artery disease-reporting and data system (CAD-RADS) was recently developed to standardize CAD classifications and incorporate clinical management. We aimed to investigate the prognostic value and additional risk stratification benefits of CAD-RADS compared to coronary artery calcium scores (CACS) and CAD extent classifications in ischemic stroke patients without cardiac symptoms.

      Methods

      From January 2013 to December 2014, 762 ischemic stroke patients with risk factors for CAD and without chest pain underwent coronary computed tomography angiography. CACS, CAD extent classification, and CAD-RADS scores were used to evaluate the computed tomography angiography images. The primary endpoint was major adverse cardiovascular events (MACEs), which were defined as cardiovascular death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and revascularization.

      Results

      During the mean follow-up period of 3.36 years, 67 MACEs were recorded. Of the 762 patients, 23.5% were classified as CAD-RADS 0, 19.7% as CAD-RADS 1, 18.2% as CAD-RADS 2, 18.6% as CAD-RADS 3, 15.4% as CAD-RADS 4A, 2.2% as CAD-RADS 4B, and 2.4% as CAD-RADS 5. CACS, CAD extent classification, and CAD-RADS scores independently stratified the risk of future MACEs (all p < 0.05). The C-statistics revealed that both CAD extent classification and CAD-RADS scores improved risk stratification beyond CACS (C-index: 0.767 vs. 0.715; 95% confidence interval [CI] 0.026, 0.105), and 0.781 vs. 0.715; 95% CI 0.015, 0.086).

      Conclusions

      In ischemic stroke patients without chest pain, CAD-RADS had prognostic value for future MACEs and better risk discrimination compared with CACS alone.

      Graphical abstract

      Keywords

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