Coronary Artery Disease - Reporting and Data System - SCCT/ACR/NASCI (2016)

Coronary Artery Disease - Reporting and Data System (CAD-RADSTMclassification is proposed by the Society for Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR), and the North American Society for Cardiovascular Imaging (NASCI), last updated in 2016.

This recommendation is intended for two groups of patients:

  • patients presenting with stable chest pain
  • patients presenting with acute chest pain, negative first troponin, negative or non-diagnostic electrocardiogram, and low to intermediate risk

CAD-RADS for patients presenting with stable chest pain.

  • CAD-RADS 0
    • degree of coronary stenosis is 0%
    • documented absence of CAD
    • further cardiac investigation - none
  • CAD-RADS 1
    • degree of coronary stenosis is 1%-24% (minimal)
    • minimal non-obstructive CAD 
    • further cardiac investigation - none
  • CAD-RADS 2
    • degree of coronary stenosis is 25%-49% (mild)
    • mild non-obstructive CAD 
    • further cardiac investigation - none
  • CAD-RADS 3
    • degree of coronary stenosis is 50%-69% (moderate).
    • moderate stenosis 
    • consider functional assessment.
  • CAD-RADS 4A
    • degree of coronary stenosis is 70%-99% (severe)
    • severe stenosis 
    • consider angiography or functional assessment
  • CAD-RADS 4B
    • left main >50% or three-vessel disease (>70%)
    • severe stenosis 
    • angiography recommended
  • CAD-RADS 5
    • coronary stenosis is 100% (total occlusion)
    • total coronary occlusion 
    • angiography recommended
  • CAD-RADS N
    • non-diagnostic study
    • obstructive CAD cannot be excluded
    • additional or alternative evaluation may be needed

*CAD - coronary artery disease 

CAD-RADS for patients presenting with acute chest pain, negative first troponin, negative or non-diagnostic electrocardiogram and low to intermediate risk (Thrombolysis In Myocardial Infarction (TIMI) risk score <4) (emergency department or hospital setting)

  • CAD-RADS 0
    • degree of coronary stenosis is 0%
    • acute coronary syndrome is highly unlikely 
  • CAD-RADS 1
    • degree of coronary stenosis is 1%-24% (minimal)
    • acute coronary syndrome is highly unlikely 
  • CAD-RADS 2
    • degree of coronary stenosis is 25%-49% (mild)
    • acute coronary syndrome is unlikely
  • CAD-RADS 3
    • degree of coronary stenosis is 50%-69% (moderate)
    • acute coronary syndrome is possible
  • CAD-RADS 4A
    • degree of coronary stenosis is 70%-99% (severe)
    • acute coronary syndrome is likely
  • CAD-RADS 4B
    • left main >50% or three-vessel disease (>70%)
    • acute coronary syndrome is likely
  • CAD-RADS 5
    • coronary stenosis is 100% (total occlusion)
    • acute coronary syndrome is very likely
  • CAD-RADS N
    • non-diagnostic study
    • acute coronary syndrome cannot be excluded

Management

Therapeutic approach is different for these two groups of patients.  

Management of patients presenting with stable chest pain. 

  • CAD-RADS 0
    • reassurance
    • consider non-atherosclerotic causes of chest pain 
  • CAD-RADS 1
    • consider non-atherosclerotic causes of chest pain
    • consider preventive therapy and risk factor modification 
  • CAD-RADS 2
    • 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
    • consider symptom-guided anti-ischaemic 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
    • consider symptom-guided anti-ischaemic 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 
    • consider symptom-guided anti-ischaemic 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. 

Management of patients presenting with acute chest pain, negative first troponin, negative or non-diagnostic electrocardiogram and low to intermediate risk (Thrombolysis In Myocardial Infarction (TIMI) risk score <4) (emergency department or hospital setting)

  • CAD-RADS 0
    • no further evaluation of ACS is required
    • consider other aetiologies
  • CAD-RADS 1
    • consider evaluation of non-ACS aetiology, if normal troponin and no ECG changes
    • consider referral for outpatient follow-up for preventive therapy and risk factor modification
  • CAD-RADS 2
    • consider evaluation of non-ACS aetiology, if normal troponin and no ECG changes
    • consider referral for outpatient follow-up for preventive therapy and risk factor modification
    • if clinical suspicion of ACS is high or if high-risk plaque features are noted, consider hospital admission with cardiology consultation
  • CAD-RADS 3  
    • consider hospital admission with cardiology consultation, functional testing and/or ICA for evaluation and management.
    • recommendation for anti-ischaemic and preventive management should be considered as well as risk factor modification
    • other treatments should be considered if presence of haemodynamically-significant lesion.
  • CAD-RADS 4
    • consider hospital admission with cardiology consultation. Further evaluation with ICA and revascularization as appropriate.
    • recommendation for anti-ischaemic and preventive management should be considered as well as risk factor modification
  • CAD-RADS 5 
    • consider expedited ICA on a timely basis and revascularization if appropriate if acute occlusion
    • recommendation for anti-ischaemic and preventive management should be considered as well as risk factor modifications. 
  • CAD-RADS N
    • additional or alternative evaluation for ACS is needed 

* ACS - acute coronary syndrome

If more than one modifier is present, the symbol “/” (slash) should follow each modifier in the following order:

  • modifier N (non-diagnostic)
  • modifier S (stent)
  • modifier G (graft)
  • modifier V (vulnerability)

For example:

  • non-interpretable coronary stent without evidence of other obstructive coronary disease: modifier S = CAD-RADS N/S
  • presence of stent and a new moderate stenosis showing a plaque with high-risk features: modifiers S and V=CAD-RADS 3/S/V
  • presence of stent, grafts and non-evaluable segments due to metal artifacts: modifiers S and G=CAD-RADS N/S/G
  • presence of patent left internal mammary artery (LIMA) to the left anterior descending artery(LAD) and expected occluded proximal LAD. Mild non-obstructive stenosis in the right coronary artery (RCA) and left circumflex artery (LCx. modifier G = CAD-RADS 2/G
  • for a patient with severe stenosis (70-99%) in one segment and a non-diagnostic area in another segment, the study should be graded as CAD-RADS 4/N

See also

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Article information

rID: 56786
System: Cardiac, Vascular
Synonyms or Alternate Spellings:
  • CAD-RADS
  • Coronary artery disease - reporting and data system

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