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

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.