The prognostic value of preoperative CAD-RADS classification in patients undergoing isolated aortic valve surgery.

To investigate the association between preoperative coronary artery disease (CAD) severity, as classified by the Coronary Artery Disease Reporting and Data System (CAD-RADS), and clinical outcomes in patients undergoing isolated aortic valve replacement (AVR). A total of 897 patients (452 women; mean age, 66.1 ± 9.3 years) who underwent isolated AVR and preoperative coronary computed tomography angiography (CCTA) between 2004 and 2022 were stratified by the CAD-RADS score. The outcomes of interest were all-cause death and major adverse cardiac and cerebrovascular events (MACCE). The CAD-RADS score was 0 in 290 (32%) patients, 1 in 208 (23%), 2 in 255 (29%), 3 in 82 (9%), and 4 in 62 (7%) patients. The rates of all-cause death and MACCE tended to increase in parallel with CAD-RADS score (4%, 10.5%, 8.2%, 18.2%, 28.1% at 5 years and 14.4%, 15.1%, 16.7%, 26.9%, 38.4% at 5 years, both P < 0.001). CAD-RADS score ≥ 3 was associated with a higher risk of all-cause death (HR 2.44, 95% CI: 1.52-3.93) and MACCE (HR 1.79, 95% CI: 1.27-2.52) after adjusting for potential confounders. Notably, patients with CAD-RADS ≥ 3 who received medical therapy in addition to coronary angiography (CAG) improved overall survival compared to those who did not undergo CAG. Preoperative CCTA with CAD-RADS assessment would be useful for screening concomitant CAD and predicting long-term clinical outcomes including all-cause death and MACCE in patients undergoing isolated AVR. For patients with CAD-RADS ≥ 3, it is essential to implement medicinal therapy or intervention along with CAG.