New coronary computed tomography angiography (CCTA) research suggests that CAD-RADS 2.0 plaque burden grades have no impact in predicting cardiac events in patients who present with acute chest pain.
For the retrospective multicenter study, recently published in the American Journal of Roentgenology, researchers examined CCTA data to determine the prognostic value of different CAD-RADS categories, high-risk plaque and plaque burden for 2,032 patients (mean age of 58.4) who presented with acute chest pain. The median follow-up period was 15.2 months, according to the study.
In a multivariable analysis, the study authors found that CAD-RADS 3, CAD-RADS 4 and CAD-RADS 5 presentations were associated with 7.1 times higher, 13.6 times higher and 17.6 times higher risk, respectively, for future cardiac events. They also determined that high-risk plaque was 2.5 times more likely to be associated with future cardiac events.
However, the researchers determined there were no significant associations between cardiac events and plaque burden grades of P1, P2, P3 or P4.
“ … The present findings do not support a significant independent benefit of plaque burden grades determined using quantitative CAC scores in patients presenting to the ED with acute chest pain,” wrote lead study author Ji Won Lee, M.D., Ph.D., who is affiliated with the Department of Radiology at Pusan National University Hospital and the Pusan National University School of Medicine and Medical Research Institute in Busan, Korea, and colleagues.
Three Key Takeaways
- Plaque burden grades have limited prognostic value.
CAD-RADS 2.0 plaque burden grades showed no significant association with future cardiac events in patients presenting with acute chest pain. - CAD-RADS categories and high-risk plaque are stronger predictors. Patients with CAD-RADS 3, 4, or 5 had 7.1x, 13.6x, and 17.6x higher risks of future cardiac events, respectively. High-risk plaque was associated with a 2.5x increased risk of future events.
- Risk stratification should prioritize CAD-RADS and high-risk plaque. Nearly 27 percent of patients with a P0 plaque burden grade who had cardiac events still had high CAD-RADS scores or high-risk plaque, emphasizing the need to integrate multiple CCTA features in clinical decision-making.
The study authors pointed out that 27 percent of patients who had a cardiac event had a P0 grade for plaque burden. They also noted that out of the 17 patients who had a P0 plaque burden grade and a cardiac event, 11 patients had CAD-RADS 4 presentations, CAD-RADS 5 presentations or high-risk plaque.
“Such observations underscore the importance of integrating other factors, including CAD-RADS categories and presence of high-risk plaque features, in risk stratification,” emphasized Lee and colleagues.
(Editor’s note: For related content, see “Can Emerging AI Software Offer Detection of CAD on CCTA on Par with Radiologists?,” “Medicare to Cover AI-Powered, CCTA-Based Coronary Plaque Analysis and Quantitative Coronary Topography” and “Large CT Study Shows Benefits of AI in Predicting CV Risks in Patients without Obstructive CAD.”)
In regard to study limitations, the authors acknowledged the possibility of patient selection bias given the retrospective nature of the research. The researchers pointed out that they didn’t assess more granular aspects of plaque location and distribution for prognostic impact beyond the CAD-RADS 2.0 plaque burden grades. The study authors also noted that evaluation for possible myocardial infarction did not consider MRI or echocardiography findings.
