Coronary disease & ACSCohort study

Incremental Predictive Value of Deep Learning–Quantified Coronary Atherosclerotic Volume

JACC Cardiovasc ImagingPublished

  • Prospective cohort study
  • population-based

Authors' conclusion

Automated deep learning-quantified TPV improved prediction of first coronary events beyond SCORE2, coronary artery calcium score, and manually derived coronary CTA measurements, and identified even small plaque volumes associated with increased risk in a general population without established atherosclerotic cardiovascular disease.

Study context

Population
Randomly selected men and women 50–64 years from a population-based cohort, without prior atherosclerotic CVD, with SCORE2 data and coronary computed tomography angiography (CTA) of acceptable quality287 coronary events
Participants
23,314 participants
Exposure
Deep learning-quantified total plaque volume (TPV) added to SCORE2 and segment involvement score vs SCORE2 and segment involvement score alone
Outcome
CHD death or MI
Follow-up
Median 7.8 years

Main finding

As reported in the abstract

Incremental prediction of coronary events by TPV

C-statistic, SCORE2 + segment involvement score + TPV vs without TPV

0.798 vs 0.783; P = 0.022

Net reclassification index with TPV added

0.093 (95% CI: 0.041-0.146)

HR, highest TPV category

6.36 (95% CI: 3.00-13.52)

Observational data: associations, not effects.

Further findings

Adding stenosis ≥50% or any segment with only noncalcified plaque

Did not materially improve the C-statistic

Noncalcified plaque volume (NCPV) instead of TPV

Similar results

Original publication

Incremental Predictive Value of Deep Learning–Quantified Coronary Atherosclerotic Volume. JACC Cardiovasc Imaging. Published 21 August 2026. doi:10.1016/j.jcmg.2026.08.004

Summarised from the published abstract; every number is checked against it