Key result
AI-QCT reduces downstream testing ~37% and improves diagnostic confidence vs conventional CCTA.
Why the study?
The incremental impact of atherosclerosis imaging-quantitative computed tomography (AI-QCT) on diagnostic certainty and downstream patient management was not yet known.
Does atherosclerosis imaging-quantitative computed tomography (AI-QCT) improve diagnostic certainty and alter downstream management compared to conventional visual CCTA in adult patients?
Does atherosclerosis imaging-quantitative computed tomography (AI-QCT) improve diagnostic certainty and alter downstream management compared to conventional visual CCTA in adult patients?
The routine use of AI-QCT significantly alters clinical decision-making, reducing the need for downstream testing while increasing appropriate preventive medical therapy compared to visual CCTA alone.
AI-QCT was associated with higher diagnostic confidence and fewer downstream tests; leaves open impact on outcomes pending prospective trials.
Aims The incremental impact of atherosclerosis imaging-quantitative computed tomography (AI-QCT) on diagnostic certainty and downstream patient management is not yet known. The aim of this study was to compare the clinical utility of the routine implementation of AI-QCT versus conventional visual coronary CT angiography (CCTA) interpretation. Methods and results In this multi-centre cross-over study in 5 expert CCTA sites, 750 consecutive adult patients referred for CCTA were prospectively recruited. Blinded to the AI-QCT analysis, site physicians established patient diagnoses and plans for downstream non-invasive testing, coronary intervention, and medication management based on the conventional site assessment. Next, physicians were asked to repeat their assessments based upon AI-QCT results. The included patients had an age of 63.8 ± 12.2 years; 433 (57.7%) were male. Compared with the conventional site CCTA evaluation, AI-QCT analysis improved physician’s confidence two- to five-fold at every step of the care pathway and was associated with change in diagnosis or management in the majority of patients (428; 57.1%; P < 0.001), including for measures such as Coronary Artery Disease-Reporting and Data System (CAD-RADS) (295; 39.3%; P < 0.001) and plaque burden (197; 26.3%; P < 0.001). After AI-QCT including ischaemia assessment, the need for downstream non-invasive and invasive testing was reduced by 37.1% (P < 0.001), compared with the conventional site CCTA evaluation. Incremental to the site CCTA evaluation alone, AI-QCT resulted in statin initiation/increase an aspirin initiation in an additional 28.1% (P < 0.001) and 23.0% (P < 0.001) of patients, respectively. Conclusion The use of AI-QCT improves diagnostic certainty and may result in reduced downstream need for non-invasive testing and increased rates of preventive medical therapy.
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Nurmohamed et al. (2024) studied this question. AI-QCT improved diagnostic confidence two- to five-fold and reduced the need for downstream testing by 37.1% compared to conventional CCTA evaluation (P < 0.001).
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