CAD-RADS 2.0-guided diagnostic pathways in chronic coronary syndromes: a real-world Polish registry of over 10 000 patients.

Background

Coronary computed tomography angiography (CCTA) reported with Coronary Artery Disease Reporting and Data System (CAD-RADS) 2.0 is increasingly used in chronic coronary syndromes, but real-world adherence to the recommended downstream pathways is poorly characterized.

Aims

To describe the population referred for CCTA in a Polish tertiary center, the distribution of CAD-RADS 2.0 categories by sex and age, and adherence to guideline-recommended downstream pathways.

Methods

We retrospectively analyzed 10 005 consecutive patients who underwent CCTA between July 1, 2022 and December 31, 2024. Downstream procedures were identified in the National Health Fund registry. A pre-specified multivariable logistic regression model (CAD-RADS category, age, sex) described referral for invasive coronary angiography (ICA); discrimination was quantified as the area under the receiver-operating-characteristic curve (AUC).

Results

Women constituted 57.8% of the cohort and were older than men (mean 66.4 vs. 64.1 years; P < 0.001). The distribution of categories differed by sex (P < 0.001). Among patients with CAD-RADS 0-2, 18.5% underwent at least one additional test. Among patients with CAD-RADS 3, 41.8% proceeded directly to ICA without prior functional testing and 17.7% followed a functional-testing-first pathway. Among patients with CAD-RADS 4-5, 26.0% did not undergo ICA and 17.8% had no further testing. CAD-RADS category dominated referral for ICA (full model AUC 0.886; 95% confidence interval, 0.877-0.894; CAD-RADS alone 0.883; age and sex alone 0.677).

Conclusions

Divergence between observed and guideline-recommended pathways was evident across all CAD-RADS categories, indicating a need for structured implementation of CAD-RADS-guided care pathways.