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Coronary disease & ACSCohort study

Prognostic Value of AI-Based Quantitative Coronary Computed Tomography Angiography (CTA) vs Human Reader-Based Visual Assessment

JACC Cardiovasc ImagingPublished

  • Multicentre international observational cohort study (CONFIRM2 registry)
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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

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

OutcomeAUCP value
Excluding 195 patients with severe stenosis (≥70%) — AI-QCT vs CAD-RADS · MACE; NRI: 0.54; P < 0.0010.77 vs 0.72P < 0.001
Excluding 195 patients with severe stenosis (≥70%) — AI-QCT vs CAD-RADS · death/MI; NRI: 0.69; P = 0.0010.81 vs 0.73P = 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. JACC Cardiovasc Imaging. Published 1 December 2025. doi:10.1016/j.jcmg.2025.09.021
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Summarised from the published abstract; every number is checked against it