Development and Validation of a Quantitative Coronary CT Angiography Model for Diagnosis of Vessel-Specific Coronary Ischemia
Authors' conclusion
This newly developed coronary CTA-based ischemia model using coronary atherosclerosis and vascular morphology characteristics accurately diagnoses coronary ischemia by invasive FFR and provides robust prognostic utility for MACE beyond presence of stenosis.
Study context
- Population
- Symptomatic patients with suspected stable CAD; reference standard invasive FFR ≤0.80
- Comparison
- AI-QCT ischemia model vs fractional flow reserve by CT (FFRCT), myocardial perfusion imaging (MPI)
- Outcome
- Diagnostic performance (per-patient AUC) for coronary ischemia (FFR ≤0.80)
Methodological detailspost hoc analysis of CREDENCE and PACIFIC-1
- Post hoc analysis of CREDENCE and PACIFIC-1
Performance
As reported in the abstract
Per-patient AUC, CREDENCE validation (n = 305)
| Test or model | AUC |
|---|---|
| AI-QCTISCHEMIA | 0.80 (95% CI: 0.75-0.85) |
| FFRCT | 0.69 (95% CI: 0.63-0.74; P < 0.001) |
| MPI | 0.65 (95% CI: 0.59-0.71; P < 0.001) |
AUC
AI-QCTISCHEMIA0.80 (95% CI: 0.75-0.85)
FFRCT0.69 (95% CI: 0.63-0.74; P < 0.001)
MPI0.65 (95% CI: 0.59-0.71; P < 0.001)
Further findings
| Outcome | aHR (95% CI) | P value | |
|---|---|---|---|
| MACE, positive AI-QCTISCHEMIA test (PACIFIC-1)Positive AI-QCTISCHEMIAvs Negative AI-QCTISCHEMIA | 7.6 (1.2–47.0) | P = 0.030 | |
| 0.050.21520Adjusted hazard ratio (log scale) |
| Outcome | AI-QCTISCHEMIA | FFRCT | PET | SPECT |
|---|---|---|---|---|
| Per-patient AUC, PACIFIC-1 (n = 208)P values vs AI-QCTISCHEMIA | ||||
| AUC | 0.85 (95% CI: 0.79-0.91) | 0.78 (95% CI: 0.72-0.84; P = 0.037) | 0.89 (95% CI: 0.84-0.93; P = 0.262) | 0.72 (95% CI: 0.67-0.78; P < 0.001) |
- Major adverse cardiovascular events (MACE), positive AI-QCTISCHEMIA test (PACIFIC-1): adjusted for clinical risk factors and computed tomography angiography (CTA) obstructive stenosis
Original publication
Development and Validation of a Quantitative Coronary CT Angiography Model for Diagnosis of Vessel-Specific Coronary Ischemia. JACC Cardiovasc Imaging. Published 13 March 2024. doi:10.
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