The Case For CTAA

TLDR: This figure shows that a CCTA with clearly overlay is a useful prognostic tool for prediction bad heart things over the next 10 years above and beyond the current risk stratification tools used to date.

The study, published March of 2024, looked at 536 individuals that had a CCTA imaging which used an Artificial Intelligence over read to give a "percentage atheroma volume" metric. It looked at how good this AI generated score of percentage atheroma volume (PAV) was as predicting 10 year risk of major adverse cardiac event (MACE). 

• PAV is defined as (plaque volume/vessel volume) x 100.

• MACE is bad things happening to your heart or brain, defined as nonfatal heart attacks (MIs), nonfatal strokes, death, coronary revascularization. 

This metric went on to be a very good predictor of bad things happening to the heart and brain over the next 10 years.

You will notice that the more plaque per vessel, the more bad things happen in a very clear dose dependent manner.

An important thing to note: at the time of imaging, the patients had no history of CAD. If we are going to look at this imaging study as a screening tool in individuals that have not had a heart attack or stroke before, this is the population we want to study.

Take home: While CCTA does deliver a dose of ionizing radiation and the cost of the study is often not covered by insurance in an individual that has not had an MI before, one needs to weigh these negative against the fact that the study can provide valuable insight into your risk of a major adverse event to your heart or brain over the next 10 years above and beyond what is currently available.

LINK to study

Nurmohamed, N, Bom, M, Jukema, R. et al. AI-Guided Quantitative Plaque Staging Predicts Long-Term Cardiovascular Outcomes in Patients at Risk for Atherosclerotic CVD. J Am Coll Cardiol Img. 2024 Mar, 17 (3) 269–280.https://doi.org/10.1016/j.jcmg.2023.05.020