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
Graphical Abstract
Keywords
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Article Info
Publication History
Published online: May 27, 2019
Accepted:
May 15,
2019
Received in revised form:
April 10,
2019
Received:
October 5,
2018
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
