Artificial intelligence-guided quantitative coronary CT assessment to rule-in or rule-out myocardial ischaemia
European Heart Journal - Cardiovascular Imaging, vol. 27, pp. 1192–1204
Abstract
AIMS: To evaluate the ability of artificial intelligence-based quantitative CT (AI-QCT) parameters, diameter stenosis, percent atheroma volume (PAV) and average lumen area (ALA) to rule-in or rule-out ischaemia. METHODS AND RESULTS: This post-hoc, vessel-level analysis included patients with suspected coronary artery disease from the computed tomographic evaluation of atherosclerotic determinants of myocardial ischaemia (CREDENCE) (612 patients; 1727 vessels) and PACIFIC-1 (208 patients; 612 vessels) studies who underwent CCTA and invasive fractional flow reserve (FFR). In addition to diameter stenosis, PAV and ALA were evaluated as key predictors of ischaemia. We report abnormal FFR prevalence based on these variables and define rule-out (<15% ischaemia prevalence, defer further testing), rule-in (>75% prevalence, ischaemia highly likely; further testing typically unnecessary), and intermediate risk (15-75%, consider additional functional assessment). PAV and ALA were dichotomized using median values derived from the CREDENCE cohort (14.7% and 3.9 mm2) and validated in PACIFIC-1. In CREDENCE, all vessels with 1-24% stenosis were ruled-out. Among vessels with 25-49% stenosis, 74% met rule-out criteria, while 26%, characterized by large PAV and small ALA, were intermediate risk. Within the proposed9723 framework vessels with 50-69% stenosis were classified as intermediate risk. For 70-99% stenosis, 93% met rule-in criteria, except a small subset with small PAV and large ALA. In PACIFIC-1, 86% of vessels with <50% stenosis were ruled-out, and 61% of those with 50-99% stenosis were ruled-in. CONCLUSION: A simplified framework incorporating AI-QCT parameters including diameter stenosis, PAV (>14.7%), and ALA (<3.9 mm2), stratifies myocardial ischaemia risk. Most non-obstructive lesions can be ruled-out, while most stenoses >70% are reliably ruled-in. This practical approach enhances the diagnostic utility of CCTA and streamlines clinical decision-making.
Authors 42
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University of Brawijaya · Leiden University Medical Center
Affiliation as printed
Department of Cardiology, Leiden University Medical Center , Albinusdreef 2, Leiden 2333 ZA ,
Faculty of Medicine, Universitas Brawijaya , Malang ,
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam · University of Amsterdam
Affiliation as printed
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam ,
Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam , Amsterdam ,
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Radboud University Medical Center
Affiliation as printed
Department of Cardiology, Radboud University Medical Center , Nijmegen ,
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam ,
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam ,
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam ,
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam ,
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam ,
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University of Milan · Centro Cardiologico Monzino
Affiliation as printed
Department of Biomedical, Surgical and Dental Sciences, University of Milan , Milan ,
Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS , Milan, Italy
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IRCCS Ospedale Galeazzi - Sant'Ambrogio
Affiliation as printed
Department of University Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant’Ambrogio , Milan ,
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Yonsei University · Severance Hospital · Yonsei University Health System
Affiliation as printed
Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System , Seoul ,
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Affiliation as printed
Division of Cardiology, The George Washington University School of Medicine , Washington, DC ,
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Affiliation as printed
Division of Cardiology, The George Washington University School of Medicine , Washington, DC ,
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam ,
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University of Turku · Leiden University Medical Center · Turku University Hospital
Affiliation as printed
Department of Cardiology, Leiden University Medical Center , Albinusdreef 2, Leiden 2333 ZA ,
Heart Center, Turku University Hospital and University of Turku , Turku ,
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Utrecht University · University Medical Center Utrecht
Affiliation as printed
Department of Cardiology, Division of Heart and Lungs, Utrecht University, Utrecht University Medical Center , Utrecht ,
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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Yonsei University · Yonsei University Health System
Affiliation as printed
Severance Biomedical Science Institute , Yonsei University College of Medicine , Yonsei University Health System , Seoul , South Korea;
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