Reporting trends and clinical impact of high-risk coronary plaques on cardiac CT angiography in CAD-RADS.

Abstract

To evaluate the reporting trends and clinical impact of the CAD-RADS modifier high-risk plaque (HRP). Radiology reports of cardiac CT angiography performed in a tertiary referral hospital between October 2017 and December 2021 were retrospectively reviewed. Cases coded with modifier HRP or with CT reports mentioning HRP were defined as "HRP-reported." The prevalence of HRP-reported cases was analyzed. Subsequent management within 90 days post-CT was reviewed for cases with suspected stable angina. Among the 21503 cases (mean age, 62.7 years ± 12.3 [SD]; 11,127 men) enrolled, 169 cases (0.8%) were HRP-reported. HRP-reported cases were more frequent in cases with suspected acute coronary syndrome or stable angina than others (1.2% vs. 1.1% vs. 0.1%; p < 0.001), protocols for coronary CT angiography or triple-rule-out CT, compared to others (1.1% vs. 0.7% vs. 0.1%; p < 0.001), and cases with higher coronary artery calcium or CAD-RADS categories (p for trends < 0.001). HRP reporting rates varied among the readers, ranging from 0.1 to 1.3%. In the setting of suspected stable angina, the HRP-reported group more frequently underwent invasive coronary angiography in CAD-RADS 1-2 (8.8% vs. 1.4%; p = 0.01), stress testing in CAD-RADS 3 (38.5% vs. 18.4%; p = 0.02), and coronary revascularization in CAD-RADS 3 (23.1% vs. 8.7%; p = 0.02) or 4-5 (75.0% vs. 54.6%; p = 0.001). The CAD-RADS modifier HRP impacted the management of patients with CAD. However, its reporting prevalence was low and varied depending on the readers and clinical settings. Question Data on the real-world clinical use of CAD-RADS high-risk plaque features on cardiac CT angiography are limited. Findings The reporting prevalence of high-risk plaque was low and varied among radiologists and clinical settings in a large academic hospital. Clinical relevance This study reveals the underreporting and variability in reporting practices of high-risk plaque on cardiac CT angiography, despite its importance in managing patients with coronary artery disease.