Prognostic value of a novel artificial intelligence-based coronary computed tomography angiography-derived ischaemia algorithm for patients with suspected coronary artery disease
European Heart Journal - Cardiovascular Imaging, vol. 25, pp. 657–667
Abstract
AIMS: Coronary computed tomography angiography (CTA) imaging is used to diagnose patients with suspected coronary artery disease (CAD). A novel artificial intelligence-guided quantitative computed tomography ischaemia algorithm (AI-QCTischaemia) aims to identify myocardial ischaemia directly from CTA images and may be helpful to improve risk stratification. The aims were to investigate (i) the prognostic value of AI-QCTischaemia amongst symptomatic patients with suspected CAD entering diagnostic imaging with coronary CTA and (ii) the prognostic value of AI-QCTischaemia separately amongst patients with no/non-obstructive CAD (≤50% visual diameter stenosis) and obstructive CAD (>50% visual diameter stenosis). METHODS AND RESULTS: For this cohort study, AI-QCTischaemia was calculated by blinded analysts amongst patients with suspected CAD undergoing coronary CTA. The primary endpoint was the composite of death, myocardial infarction (MI), or unstable angina pectoris (uAP) (median follow-up 6.9 years). A total of 1880/2271 (83%) patients had conclusive AI-QCTischaemia result. Patients with an abnormal AI-QCTischaemia result (n = 509/1880) vs. patients with a normal AI-QCTischaemia result (n = 1371/1880) had significantly higher crude and adjusted rates of the primary endpoint [adjusted hazard ratio (HRadj) 1.96, 95% confidence interval (CI) 1.46-2.63, P < 0.001; covariates: age/sex/hypertension/diabetes/smoking/typical angina]. An abnormal AI-QCTischaemia result was associated with significantly higher crude and adjusted rates of the primary endpoint amongst patients with no/non-obstructive CAD (n = 1373/1847) (HRadj 1.81, 95% CI 1.09-3.00, P = 0.022), but not amongst those with obstructive CAD (n = 474/1847) (HRadj 1.26, 95% CI 0.75-2.12, P = 0.386) (P-interaction = 0.032). CONCLUSION: Amongst patients with suspected CAD, an abnormal AI-QCTischaemia result was associated with a two-fold increased adjusted rate of long-term death, MI, or uAP. AI-QCTischaemia may be useful to improve risk stratification, especially amongst patients with no/non-obstructive CAD on coronary CTA.
Authors 8
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University of Turku · University Hospital of Bern · Turku University Hospital · Turku PET Centre
Affiliation as printed
Department of Cardiology, Bern University Hospital Inselspital , Bern , Switzerland
Turku PET Centre, Turku University Hospital, University of Turku , Kiinamyllynkatu 4-8, 20520 Turku , Finland
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Leiden University Medical Center
Affiliation as printed
Department of Cardiology, Leiden University Medical Center , Leiden , The Netherlands
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University of Turku · Turku University Hospital · Turku PET Centre
Affiliation as printed
Department of Clinical Physiology, Nuclear Medicine, and PET, Turku University Hospital , Hämeentie 11, 20540 Turku , Finland
Turku PET Centre, Turku University Hospital, University of Turku , Kiinamyllynkatu 4-8, 20520 Turku , Finland
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University of Turku · Turku University Hospital · Turku PET Centre
Affiliation as printed
Heart Center, Turku University Hospital, University of Turku , Turku , Finland
Turku PET Centre, Turku University Hospital, University of Turku , Kiinamyllynkatu 4-8, 20520 Turku , Finland
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Leiden University Medical Center
Affiliation as printed
Department of Cardiology, Leiden University Medical Center , Leiden , The Netherlands
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Affiliation as printed
Cleerly Inc. , NewYork, NY , USA
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Affiliation as printed
Cleerly Inc. , NewYork, NY , USA
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Juhani M. Knuuti corresponding
University of Turku · Turku University Hospital · Turku PET Centre
Affiliation as printed
Department of Clinical Physiology, Nuclear Medicine, and PET, Turku University Hospital , Hämeentie 11, 20540 Turku , Finland
Turku PET Centre, Turku University Hospital, University of Turku , Kiinamyllynkatu 4-8, 20520 Turku , Finland
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