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CAD-RADS reporting and data system for patients presenting with stable chest pain

CAD-RADS reporting and data system for patients presenting with stable chest pain
  Degree of maximal coronary stenosis Interpretation Further cardiac investigation Management
CAD-RADS 0 0% (no plaque or stenosis) Documented absence of CAD None
  • Reassurance. Consider non-atherosclerotic causes of chest pain.
CAD-RADS 1 1 to 24% (minimal stenosis or plaque with no stenosis*) Minimal non-obstructive CAD None
  • Consider non-atherosclerotic causes of chest pain.
  • Consider preventive therapy and risk factor modification.
CAD-RADS 2 25 to 49% (mild stenosis) Mild non-obstructive CAD None
  • Consider non-atherosclerotic causes of chest pain.
  • Consider preventive therapy and risk factor modification, particularly for patients with non-obstructive plaque in multiple segments.
CAD-RADS 3 50 to 69% (moderate stenosis) Moderate stenosis Consider functional assessment
  • Consider symptom-guided anti-ischemic and preventive pharmacotherapy as well as risk factor modification per guideline-directed care.
  • Other treatments should be considered per guideline-directed care.
CAD-RADS 4

A: 70 to 99% (severe stenosis)

or

B: >50% (left main) or ≥70% (3-vessel) obstructive disease 		Severe stenosis

A: Consider ICA or functional assessment

B: ICA is recommended
  • Consider symptom-guided anti-ischemic and preventive pharmacotherapy as well as risk factor modification per guideline-directed care.
  • Other treatments (including options of revascularization) should be considered per guideline-directed care.
CAD-RADS 5 100% (total occlusion) Total coronary occlusion Consider ICA and/or viability assessment
  • Consider symptom-guided anti-ischemic and preventive pharmacotherapy as well as risk factors modification per guideline-directed care.
  • Other treatments (including options of revascularization) should be considered per guideline-directed care.
CAD-RADS N Non-diagnostic study Obstructive CAD cannot be excluded Additional or alternative evaluation may be needed  
The CAD-RADS classification should be applied on a per-patient basis for the clinically most relevant (usually highest-grade) stenosis. All vessels greater than 1.5 mm in diameter should be graded for stenosis severity. CAD-RADS will not apply for smaller vessels (<1.5 mm in diameter).
MODIFIERS: If more than one modifier is present, the symbol "/" (slash) should follow each modifier in the following order:
  • First: modifier N (non-diagnostic)
  • Second: modifier S (stent)
  • Third: modifier G (graft)
  • Fourth: modifier V (vulnerability)
CAD-RADS: coronary artery disease-reporting and data system; CAD: coronary artery disease; ICA: invasive coronary angiography; ACC: American College of Cardiology.
* CAD-RADS 1 — This category should also include the presence of plaque with positive remodeling and no evidence of stenosis.
Refer to UpToDate content on secondary prevention of atherosclerotic cardiovascular disease.
Reproduced from: Cury RC, Abbara S, Achenbach S, et al. CAD-RADSTM Coronary Artery Disease — Reporting and Data System. An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology. J Cardiovasc Comut Tomogr 2016; 10:269. Table used with the permission of Elsevier Inc. All rights reserved.
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