Skip to main content
SpringerLink
Log in

Invasive coronary angiography findings across the CAD-RADS classification spectrum

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

The recently introduced coronary artery disease reporting and data system (CAD-RADS) evaluated by computed tomography and based on stenosis severity, might not adequately reflect the complexity of CAD. We explored the relationship between CAD-RADS and the spatial distribution, burden, and complexity of lesions by invasive coronary angiography (ICA). Stable patients who underwent coronary computed tomography angiography (CCTA) and ICA comprised the study population. Patients were classified according to the CAD-RADS: 0, No plaque; 1, 1–24% stenosis; 2, 25–49%; 3, 50–69%; 4A, 70–99%; 4B, left main stenosis or 3-vessel obstructive disease; and 5, total occlusion. Based on ICA findings, we calculated the SYNTAX score and the CAD extension index. Ninety-one patients were included, with a mean age of 61.4 ± 10.5 years (74% male). We found significant relationships between CAD-RADS and both the SYNTAX score (p < 0.0001) and the CAD extension index (p < 0.0001), although the complexity of coronary anatomy differed among patients with CAD-RADS ≥ 4A. Among patients with CAD-RADS < 4, the mean segment involvement score (SIS) was 8.4 ± 4.0, 52% of them with a SIS > 5. Of the 30 patients with CAD-RADS 5, 9 (30%) affected distal segments or secondary branches, and 9 (30%) had concomitant severe non-extensive disease at ICA. Regarding the spatial distribution of the non-occluded most severe lesions, 27 (44%) comprised distal segments or secondary branches. In the present study including a high-risk population, we identified diverse coronary anatomy complexity scenarios and relevant differences in spatial distribution sharing the same CAD-RADS classification.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Cury RC, Abbara S, Achenbach S et al (2016) CAD-RADS: Coronary Artery Disease - Reporting and Data System: An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology. J Am Coll Radiol 13(12 Pt A):1458–1466 e1459

    Article  Google Scholar 

  2. Xie JX, Cury RC, Leipsic J (2018) The coronary artery disease–reporting and data system (CAD-RADS) prognostic and clinical implications associated with standardized coronary computed tomography angiography reporting. J Am Coll Cardiol 11:78–89

    Article  Google Scholar 

  3. Foldyna B, Szilveszter B, Scholtz JE et al (2018) CAD-RADS - a new clinical decision support tool for coronary computed tomography angiography. Eur Radiol 28(4):1365–1372

    Article  Google Scholar 

  4. Cury RC, Feuchtner GM, Batlle JC et al (2013) Triage of patients presenting with chest pain to the emergency department: implementation of coronary CT angiography in a large urban health care system. AJR Am J Roentgenol 200(1):57–65

    Article  Google Scholar 

  5. Arbab-Zadeh A (2018) The challenge of effectively reporting coronary angiography results from computed tomography. JACC Cardiovasc Imaging 11(1):90–93

    Article  Google Scholar 

  6. Leipsic J, Abbara S, Achenbach S et al (2014) SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 8(5):342–358

    Article  Google Scholar 

  7. Halliburton SS, Abbara S, Chen MY et al (2011) SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT. J Cardiovasc Comput Tomogr 5(4):198–224

    Article  Google Scholar 

  8. Girasis C, Garg S, Raber L et al (2011) SYNTAX score and Clinical SYNTAX score as predictors of very long-term clinical outcomes in patients undergoing percutaneous coronary interventions: a substudy of SIRolimus-eluting stent compared with pacliTAXel-eluting stent for coronary revascularization (SIRTAX) trial. Eur Heart J 32(24):3115–3127

    Article  Google Scholar 

  9. Score S (2017) http://www.syntaxscorecom Accessed Mar 2017

  10. van Rosendael AR, Shaw LJ, Xie JX et al (2019) Superior risk stratification with coronary computed tomography angiography using a comprehensive atherosclerotic risk score. JACC Cardiovasc Imaging. https://doi.org/10.1016/j.jcmg.2018.10.024

    Article  PubMed  Google Scholar 

  11. Hoebers LP, Elias J, van Dongen IM et al (2016) The impact of the location of a chronic total occlusion in a non-infarct-related artery on long-term mortality in ST-elevation myocardial infarction patients. EuroIntervention 12(4):423–430

    Article  Google Scholar 

  12. Varnauskas E (1988) Twelve-year follow-up of survival in the randomized European Coronary Surgery Study. New Engl J Med 319(6):332–337

    Article  CAS  Google Scholar 

  13. Elsman P, van ‘t Hof AWJ, Hoorntje JC et al (2006) Effect of coronary occlusion site on angiographic and clinical outcome in acute myocardial infarction patients treated with early coronary intervention. Am J Cardiol 97(8):1137–1141

    Article  Google Scholar 

  14. Elhendy A, Mahoney DW, Khandheria BK et al (2002) Prognostic significance of the location of wall motion abnormalities during exercise echocardiography. J Am Coll Cardiol 40(9):1623–1629

    Article  Google Scholar 

  15. Valgimigli M, Rodriguez-Granillo GA, Garcia-Garcia HM et al (2006) Distance from the ostium as an independent determinant of coronary plaque composition in vivo: an intravascular ultrasound study based radiofrequency data analysis in humans. Eur Heart J 27(6):655–663

    Article  Google Scholar 

  16. Rodriguez-Granillo GA, Garcia-Garcia HM, Wentzel J et al (2006) Plaque composition and its relationship with acknowledged shear stress patterns in coronary arteries. J Am Coll Cardiol 47(4):884–885

    Article  Google Scholar 

  17. Zheng G, Li Y, Takayama T, Nishida T et al (2016) The spatial distribution of plaque vulnerabilities in patients with acute myocardial infarction. PLoS ONE 11(3):e0152825

    Article  Google Scholar 

  18. Kolodgie FD, Burke AP, Farb A et al (2001) The thin-cap fibroatheroma: a type of vulnerable plaque: the major precursor lesion to acute coronary syndromes. Curr Opin Cardiol 16(5):285–292

    Article  CAS  Google Scholar 

  19. Toutouzas K, Karanasos A, Riga M et al (2012) Optical coherence tomography assessment of the spatial distribution of culprit ruptured plaques and thin-cap fibroatheromas in acute coronary syndrome. EuroIntervention 8(4):477–485

    Article  Google Scholar 

  20. Kume T, Okura H, Yamada R et al (2009) Frequency and spatial distribution of thin-cap fibroatheroma assessed by 3-vessel intravascular ultrasound and optical coherence tomography: an ex vivo validation and an initial in vivo feasibility study. Circ J 73(6):1086–1091

    Article  Google Scholar 

  21. Rodriguez-Granillo GA, Garcia-Garcia HM, Valgimigli M et al (2006) Global characterization of coronary plaque rupture phenotype using three-vessel intravascular ultrasound radiofrequency data analysis. Eur Heart J 27(16):1921–1927

    Article  Google Scholar 

  22. Blaha MJ, Budoff MJ, Tota-Maharaj R et al (2016) Improving the cac score by addition of regional measures of calcium distribution: multi-ethnic study of atherosclerosis. JACC Cardiovasc Imaging 9(12):1407–1416

    Article  Google Scholar 

  23. Hadamitzky M, Achenbach S, Al-Mallah M et al (2013) Optimized prognostic score for coronary computed tomographic angiography: results from the CONFIRM registry (COronary CT Angiography EvaluatioN For Clinical Outcomes: an InteRnational Multicenter Registry). J Am Coll Cardiol 62(5):468–476

    Article  Google Scholar 

  24. Ostrom MP, Gopal A, Ahmadi N et al (2008) Mortality incidence and the severity of coronary atherosclerosis assessed by computed tomography angiography. J Am Coll Cardiol 52(16):1335–1343

    Article  Google Scholar 

  25. Min JK, Dunning A, Lin FY et al (2011) Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease. J Am Coll Cardiol 58(8):849–860

    Article  Google Scholar 

  26. Maddox TM, Stanislawski MA, Grunwald GK et al (2014) Nonobstructive coronary artery disease and risk of myocardial infarction. JAMA 312(17):1754–1763

    Article  CAS  Google Scholar 

  27. Chaitman BR, Rosen AD, Williams DO et al (1997) Myocardial infarction and cardiac mortality in the Bypass Angioplasty Revascularization Investigation (BARI) randomized trial. Circulation 96(7):2162–2170

    Article  CAS  Google Scholar 

  28. Rodriguez-Granillo GA, Carrascosa P, Bruining N et al (2016) Defining the non-vulnerable and vulnerable patients with computed tomography coronary angiography: evaluation of atherosclerotic plaque burden and composition. Eur Heart J Cardiovasc Imaging 17(5):481–491

    Article  Google Scholar 

  29. Bittencourt MS, Hulten E, Ghoshhajra B et al (2014) Prognostic value of nonobstructive and obstructive coronary artery disease detected by coronary computed tomography angiography to identify cardiovascular events. Circ Cardiovasc Imaging 7(2):282–291

    Article  Google Scholar 

  30. Arbab-Zadeh A, Fuster V (2016) The risk continuum of atherosclerosis and its implications for defining CHD by coronary angiography. J Am Coll Cardiol 68(22):2467–2478

    Article  Google Scholar 

  31. Motoyama S, Ito H, Sarai M et al (2015) Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up. J Am Coll Cardiol 66(4):337–346

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ, Buenos Aires, Argentina

    Gaston A. Rodriguez-Granillo & Patricia Carrascosa

  2. Department of Interventional Cardiology, Sanatorio Guemes, Buenos Aires, Argentina

    Alejandro Goldsmit

  3. Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, USA

    Armin Arbab-Zadeh

Authors
  1. Gaston A. Rodriguez-Granillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patricia Carrascosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alejandro Goldsmit
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Armin Arbab-Zadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gaston A. Rodriguez-Granillo.

Ethics declarations

Conflict of interest

We declare that Dr. Patricia Carrascosa is consultant of GE Healthcare. There are no competing interests related to the manuscript for any of the other authors.

Ethical approval

The protocol was approved by the institutional ethics committee and all studies have been performed in accordance with the ethical standards as laid down in the 1975 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rodriguez-Granillo, G.A., Carrascosa, P., Goldsmit, A. et al. Invasive coronary angiography findings across the CAD-RADS classification spectrum. Int J Cardiovasc Imaging 35, 1955–1961 (2019). https://doi.org/10.1007/s10554-019-01654-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-019-01654-1

Keywords

Search

Navigation