Derivation and validation of an artificial intelligence-based plaque burden safety cut-off for long-term acute coronary syndrome from coronary computed tomography angiography

European Heart Journal - Cardiovascular Imaging, vol. 26, pp. 1163–1173

Abstract

AIMS: Artificial intelligence (AI) has enabled accurate and fast plaque quantification from coronary computed tomography angiography (CCTA). However, AI detects any coronary plaque in up to 97% of patients. To avoid overdiagnosis, a plaque burden safety cut-off for future coronary events is needed. METHODS AND RESULTS: Percent atheroma volume (PAV) was quantified with AI-guided quantitative computed tomography in a blinded fashion. Safety cut-off derivation was performed in the Turku CCTA registry (Finland), and pre-defined as ≥90% sensitivity for acute coronary syndrome (ACS). External validation was performed in the Amsterdam CCTA registry (the Netherlands). In the derivation cohort, 100/2271 (4.4%) patients experienced ACS (median follow-up 6.9 years). A threshold of PAV ≥ 2.6% was derived with 90.0% sensitivity and negative predictive value (NPV) of 99.0%. In the validation cohort 27/568 (4.8%) experienced ACS (median follow-up 6.7 years) with PAV ≥ 2.6% showing 92.6% sensitivity and 99.0% NPV for ACS. In the derivation cohort, 45.2% of patients had PAV < 2.6 vs. 4.3% with PAV 0% (no plaque) (P < 0.001) (validation cohort: 34.3% PAV < 2.6 vs. 2.6% PAV 0%; P < 0.001). Patients with PAV ≥ 2.6% had higher adjusted ACS rates in the derivation [Hazard ratio (HR) 4.65, 95% confidence interval (CI) 2.33-9.28, P < 0.001] and validation cohort (HR 7.31, 95% CI 1.62-33.08, P = 0.010), respectively. CONCLUSION: This study suggests that PAV up to 2.6% quantified by AI is associated with low-ACS risk in two independent patient cohorts. This cut-off may be helpful for clinical application of AI-guided CCTA analysis, which detects any plaque in up to 96-97% of patients.

Authors 12

1. Sarah Bär corresponding

   University of Turku · University Hospital of Bern · Turku University Hospital · Turku PET Centre

   Affiliation as printed

   Department of Cardiology, Bern University Hospital Inselspital , Freiburgstrasse 20, 3010 Bern ,

   Turku PET Centre, Turku University Hospital and University of Turku , P.O.Box 52, Turku FI-20521 ,

   Bern University Hospital Inselspital, Department of Cardiology , Bern ,

   Turku PET Centre, Turku University Hospital and University of Turku , Turku ,

2. Juhani M. Knuuti

   University of Turku · Turku University Hospital · Turku PET Centre

   Affiliation as printed

   Department of Clinical Physiology, Nuclear Medicine, and PET, Turku University Hospital , Turku ,

   Turku PET Centre, Turku University Hospital and University of Turku , P.O.Box 52, Turku FI-20521 ,

   Turku PET Centre, Turku University Hospital and University of Turku , Turku ,

3. Antti Saraste

   University of Turku · Turku University Hospital · Turku PET Centre

   Affiliation as printed

   Heart Center, Turku University Hospital and University of Turku , Turku ,

   Turku PET Centre, Turku University Hospital and University of Turku , P.O.Box 52, Turku FI-20521 ,

   Turku PET Centre, Turku University Hospital and University of Turku , Turku ,

4. Riku Klén

   University of Turku · Turku University Hospital · Turku PET Centre

   Affiliation as printed

   Turku PET Centre, Turku University Hospital and University of Turku , P.O.Box 52, Turku FI-20521 ,

   Turku PET Centre, Turku University Hospital and University of Turku , Turku ,

5. Tanja Kero

   Uppsala University

   Affiliation as printed

   Nuclear Medicine & PET, Department of Surgical Sciences, Uppsala University , Uppsala ,

6. Takeru Nabeta Aachen Department of Cardiology, Leiden University Medical Center Department Of Cardiology, Leiden

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center , Leiden ,

   Leiden University Medical Center, Department of Cardiology , Leiden ,

7. Jeroen Joost Bax Aachen Department of Cardiology, Leiden University Medical Center Department Of Cardiology, Leiden

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center , Leiden ,

   Leiden University Medical Center, Department of Cardiology , Leiden ,

8. Ibrahim Danad

   Amsterdam University Medical Centers · Vrije Universiteit Amsterdam

   Affiliation as printed

   Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam ,

9. Nick S. Nurmohamed

   Amsterdam University Medical Centers · Vrije Universiteit Amsterdam

   Affiliation as printed

   Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam ,

10. Ruurt Jukema

    Amsterdam University Medical Centers · Vrije Universiteit Amsterdam

    Affiliation as printed

    Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam ,

11. Paul Knaapen

    Amsterdam University Medical Centers · Vrije Universiteit Amsterdam

    Affiliation as printed

    Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam ,

12. Teemu Maaniitty

    University of Turku · Turku University Hospital · Turku PET Centre

    Affiliation as printed

    Department of Clinical Physiology, Nuclear Medicine, and PET, Turku University Hospital , Turku ,

    Turku PET Centre, Turku University Hospital and University of Turku , P.O.Box 52, Turku FI-20521 ,

    Turku PET Centre, Turku University Hospital and University of Turku , Turku ,