Prognostic Value of AI-Based Quantitative Coronary Computed Tomography Angiography (CTA) vs Human Reader-Based Visual Assessment: Results From the CONFIRM2 Registry
Authors' conclusion
AI-QCT provided incremental prognostic information compared with CAD-RADS 2.0, CACS, and the modified Duke Index for the prediction of MACE as well as the secondary endpoint of death or nonfatal MI.
Study context
- Population
- Patients undergoing clinically indicated coronary CTA; asymptomatic patients and those with cardiac history excludedall risk scores available
- Participants
- 1,916 patients
- Exposure
- AI-QCT added to CAD-RADS, coronary artery calcium score (CACS), modified Duke Index
- Outcome
- MACE:
- Death
- MI
- Stroke
- HF
- Late revascularization
- Hospital stay for unstable angina
- Follow-up
- 3 years
Methodological detailsCONFIRM2 registry
- CONFIRM2 registry
Main finding
As reported in the abstract
MACE: 87 (4.5%) events · 3 years
- AI-QCT + CAD-RADS vs CAD-RADS · net reclassification index (NRI): 0.47; P < 0.001
- AUC 0.81 vs 0.79; P < 0.001
- AI-QCT + CACS vs CACS · NRI 0.61; P < 0.001
- AUC 0.79 vs 0.70; P < 0.001
- AI-QCT + Modified Duke Index vs Modified Duke Index · NRI: 0.52; P < 0.001
- AUC 0.81 vs 0.76; P < 0.001
- AI-QCT + CAD-RADS + CACS vs CAD-RADS + CACS · NRI: 0.54; P < 0.001
- AUC 0.81 vs 0.79; P = 0.004
Observational data: associations, not effects.
Secondary outcomes
| Outcome | AUC | P value |
|---|---|---|
| Excluding 195 patients with severe stenosis (≥70%) — AI-QCT vs CAD-RADS · MACE; NRI: 0.54; P < 0.001 | 0.77 vs 0.72 | P < 0.001 |
| Excluding 195 patients with severe stenosis (≥70%) — AI-QCT vs CAD-RADS · death/MI; NRI: 0.69; P = 0.001 | 0.81 vs 0.73 | P = 0.011 |
Death/MI (secondary endpoint): 27 (1.4%) events · 3 years
- AI-QCT also improved discrimination for death/MI and when adjusted for risk factor-weighted clinical likelihood
Excluding 195 patients with severe stenosis (≥70%)
- In multivariable model of CAD-RADS and AI-QCT, only AI-QCT significantly associated with major adverse cardiac events (MACE) and death/MI
Original publication
Prognostic Value of AI-Based Quantitative Coronary CTA vs Human Reader-Based Visual Assessment: Results From the CONFIRM2 Registry. JACC Cardiovasc Imaging. Published 1 December 2025. doi:10.
Summarised from the published abstract; every number is checked against it