Coronary artery calcification and cardiovascular outcome as assessed by intravascular OCT and artificial intelligence.

Coronary artery calcification (CAC) is a marker of atherosclerosis and is thought to be associated with worse clinical outcomes. However, evidence from large-scale high-resolution imaging data is lacking. We proposed a novel deep learning method that can automatically identify and quantify CAC in massive intravascular OCT data trained using efficiently generated sparse labels. 1,106,291 OCT images from 1,048 patients were collected and utilized to train and evaluate the method. The Dice similarity coefficient for CAC segmentation and the accuracy for CAC classification are 0.693 and 0.932, respectively, close to human-level performance. Applying the method to 1259 ST-segment elevated myocardial infarction patients imaged with OCT, we found that patients with a greater extent and more severe calcification in the culprit vessels were significantly more likely to have major adverse cardiovascular and cerebrovascular events (MACCE) (p < 0.05), while the CAC in non-culprit vessels did not differ significantly between MACCE and non-MACCE groups.