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 19th, 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.