Impact of artificial intelligence (AI) based coronary plaque quantification in patient education and lipid lowering therapy

Background Coronary computed tomography angiography (CCTA) is commonly utilized to inform coronary artery disease (CAD) management. The added impact of coronary Artificial Intelligence-Quantified Coronary Plaque Analysis (AI-CPA) on medical management is less understood. Methods An observational prospective cohort study included 105 consecutive patients undergoing CCTA between June 2024 and July 2025. The degree of luminal stenosis and total plaque volume (TPV) were quantified via AI-CPA (Heartflow, Inc.). Results Following CCTA and AI-CPA, 95% of patients had a better understanding of their overall risk and were initiated on new or additional lipid lowering therapy (LLT). A significant association was observed between the baseline LDL-C and TPV: TPV increase of 8.2 mm3 per 1 mg/dL increase in LDL-C, p < 0.001. Following LLT change, there was a 67% reduction in median LDL-C 45 mg/dL (IQR 32–60 mg/dL) compared to baseline 138 mg/dL (IQR 113–155 mg/dL, p < 0.001). Higher odds of achieving ≥50% RLR (OR 1.003, 95% CI 1.000–1.005, p = 0.028) were noted as TPV increased. Conclusion AI-CPA is associated with what appears to be greater LDL-C reduction. The association between AI-CPA findings and subsequent LDL-C reduction supports the potential role of AI-CPA in patient education and management.