The value of Coronary Artery Disease – Reporting and Data System (CAD-RADS) in Outcome Prediction of CAD Patients; a Systematic Review and Meta-analysis

INTRODUCTION: Coronary computed tomographic angiography (CCTA) reporting has traditionally been operator-dependent, and no precise classification is broadly used for reporting Coronary Artery Disease (CAD) severity. The Coronary Artery Disease Reporting and Data Systems (CAD-RADS) was introduced to address the inconsistent CCTA reports. This systematic review with meta-analysis aimed to comprehensively appraise all available studies and draw conclusions on the prognostic value of the CAD-RADS classification system in CAD patients. METHOD: Online databases of PubMed, Embase, Scopus, and Web of Science were searched until September 19(th), 2022, for studies on the value of CAD-RADS categorization for outcome prediction of CAD patients. RESULTS: 16 articles were included in this systematic review, 14 of which had assessed the value of CAD-RADS in the prediction of major adverse cardiovascular events (MACE) and 3 articles investigated the outcome of all-cause mortality. Our analysis demonstrated that all original CAD-RADS categories can be a predictor of MACE [Hazard ratios (HR) ranged from 3.39 to 8.63] and all categories, except CAD-RADS 1, can be a predictor of all-cause mortality (HRs ranged from 1.50 to 3.09). Moreover, higher CAD-RADS categories were associated with an increased hazard ratio for unfavorable outcomes among CAD patients (p( for MACE) = 0.007 and p( for all-cause mortality) = 0.018). CONCLUSION: The evidence demonstrated that the CAD-RADS classification system can be used to predict incidence of MACE and all-cause mortality. This indicates that the implementation of CAD-RADS into clinical practice, besides enhancing the communication between physicians and improving patient care, can also guide physicians in risk assessment of the patients and predicting their prognosis.