Evidence map›Paper›PMID 41978317›Full record

ArticleEuropean heart journal. Cardiovascular Imaging2026

Artificial intelligence-guided quantitative coronary CT assessment to rule-in or rule-out myocardial ischaemia.

Putri Annisa Kamila, Nick S Nurmohamed, Ibrahim Danad, Ruurt A Jukema, Pieter G Raijmakers, Roel S Driessen, Michiel J Bom, Pepijn van Diemen, Gianluca Pontone, Daniele Andreini and 7 more

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Article in European heart journal. Cardiovascular Imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors.

Putri Annisa KamilaDepartment of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands.ORCID 0000-0001-8346-8183
Nick S NurmohamedDepartment of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Ibrahim DanadDepartment of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.
Ruurt A JukemaDepartment of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Pieter G RaijmakersDepartment of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Roel S DriessenDepartment of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Michiel J BomDepartment of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.ORCID 0000-0002-6326-7437
Pepijn van DiemenDepartment of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Gianluca PontoneDepartment of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy.
Daniele AndreiniDepartment of University Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy.
Hyuk-Jae ChangDivision of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.ORCID 0000-0002-6139-7545
Richard J KatzDivision of Cardiology, The George Washington University School of Medicine, Washington, DC, USA.
Andrew D ChoiDivision of Cardiology, The George Washington University School of Medicine, Washington, DC, USA.
Paul KnaapenDepartment of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.ORCID 0000-0001-8038-7898
Jeroen J BaxDepartment of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands.
Alexander van RosendaelDepartment of Cardiology, Division of Heart and Lungs, Utrecht University, Utrecht University Medical Center, Utrecht, The Netherlands.
CREDENCE and PACIFIC-1 Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsTo evaluate the ability of artificial intelligence-based quantitative CT (AI-QCT) parameters, diameter stenosis, percent atheroma volume (PAV) and average lumen area (ALA) to rule-in or rule-out ischaemia. METHODS AND

resultsThis post-hoc, vessel-level analysis included patients with suspected coronary artery disease from the computed tomographic evaluation of atherosclerotic determinants of myocardial ischaemia (CREDENCE) (612 patients; 1727 vessels) and PACIFIC-1 (208 patients; 612 vessels) studies who underwent CCTA and invasive fractional flow reserve (FFR). In addition to diameter stenosis, PAV and ALA were evaluated as key predictors of ischaemia. We report abnormal FFR prevalence based on these variables and define rule-out (<15% ischaemia prevalence, defer further testing), rule-in (>75% prevalence, ischaemia highly likely; further testing typically unnecessary), and intermediate risk (15-75%, consider additional functional assessment). PAV and ALA were dichotomized using median values derived from the CREDENCE cohort (14.7% and 3.9 mm2) and validated in PACIFIC-1. In CREDENCE, all vessels with 1-24% stenosis were ruled-out. Among vessels with 25-49% stenosis, 74% met rule-out criteria, while 26%, characterized by large PAV and small ALA, were intermediate risk. Within the proposed framework vessels with 50-69% stenosis were classified as intermediate risk. For 70-99% stenosis, 93% met rule-in criteria, except a small subset with small PAV and large ALA. In PACIFIC-1, 86% of vessels with <50% stenosis were ruled-out, and 61% of those with 50-99% stenosis were ruled-in.

conclusionA simplified framework incorporating AI-QCT parameters including diameter stenosis, PAV (>14.7%), and ALA (<3.9 mm2), stratifies myocardial ischaemia risk. Most non-obstructive lesions can be ruled-out, while most stenoses >70% are reliably ruled-in. This practical approach enhances the diagnostic utility of CCTA and streamlines clinical decision-making.

Indexed as

Artificial IntelligenceComputed Tomography AngiographyCoronary AngiographyCoronary Artery DiseaseCoronary StenosisMyocardial IschemiaAgedFemaleFractional Flow Reserve, MyocardialHumansMaleMiddle AgedRisk AssessmentSeverity of Illness Indexartificial intelligenceatherosclerosiscoronary artery diseasecoronary computed tomography angiographycoronary ischaemia

Identifiers

PMID41978317
PMCPMC13222718

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.