Coronary disease & ACSSecondary analysis
Sex differences in detection of acute coronary syndrome culprit lesion using conventional and AI-enhanced coronary CT angiography
- sub-study of the EMERALD II trial
Authors' conclusion
AI-QCPHA enhances culprit lesion prediction in obstructive ACS beyond conventional CCTA in both sexes, supporting its potential role for improved culprit lesion discrimination.
Study context
- Population
- Patients with acute coronary syndrome (ACS) who underwent coronary computed tomography angiography (CCTA) 1 month to 3 years prior to the eventpatients with 2451 lesions · women 90 · men 261
- Participants
- 351 patients
- Comparison
- Diagnostic performance of obstructive stenosis (Coronary Artery Disease-Reporting and Data System ≥ 3) and high-risk plaque (HRP) criteria was compared between women and men
- womenn = 90
- menn = 261
Primary result
As reported in the abstract
Conventional CCTA performance for obstructive stenosis and HRP by sex
- Conventional CCTA performed similarly across sexes for obstructive stenosis, whereas HRP differed by sex
Further findings
| Outcome | women | men | AUC | P value |
|---|---|---|---|---|
| ACS culprit prediction: AI-QCPHA features integrated vs conventional CCTA (AUC) — AI-QCPHA integrated vs conventional CCTA · women | 0.84 vs. 0.78 | P = 0.002 | ||
| AUC with AI-QCPHA | 0.84 | 0.82 | ||
| AUC conventional CCTA | 0.78 | 0.75 | ||
| ACS culprit prediction: AI-QCPHA features integrated vs conventional CCTA (AUC) — AI-QCPHA integrated vs conventional CCTA · men | 0.82 vs. 0.75 | P < 0.001 |
ACS culprit prediction: AI-QCPHA features integrated vs conventional CCTA (AUC)
- AI-QCPHA identified the same best features for ACS culprit prediction in both sexes
Individual predictors
- delta fractional flow reserve from coronary computed tomography angiography yielded the highest discriminatory performance in both women and men
Original publication
Sex differences in detection of acute coronary syndrome culprit lesion using conventional and AI-enhanced coronary CT angiography. Eur Heart J Cardiovasc Imaging. Published 6 October 2026. doi:10.1093/ehjci/jeag270
Summarised from the published abstract; every number is checked against it