BACKGROUND

Noninvasive cardiac testing with coronary computed tomography angiography (CCTA) and single-photon emission computed tomography (SPECT) are becoming alternatives to invasive angiography for the evaluation of obstructive coronary artery disease. We aimed to evaluate whether a novel artificial intelligence (AI)-assisted CCTA program is comparable to SPECT imaging for ischemic testing.

METHODS

CCTA images were analyzed using an artificial intelligence convolutional neural network machine-learning-based model, atherosclerosis imaging-quantitative computed tomography (AI-QCT) ISCHEMIA . A total of 183 patients (75 females and 108 males, with an average age of 60.8 years ± 12.3 years) were selected. All patients underwent AI-QCT ISCHEMIA -augmented CCTA, with 60 undergoing concurrent SPECT and 16 having invasive coronary angiograms. Eight studies were excluded from analysis due to incomplete data or coronary anomalies.

RESULTS

A total of 175 patients (95%) had CCTA performed, deemed acceptable for AI-QCT ISCHEMIA interpretation. Compared to invasive angiography, AI-QCT ISCHEMIA -driven CCTA showed a sensitivity of 75% and specificity of 70% for predicting coronary ischemia, versus 70% and 53%, respectively for SPECT. The negative predictive value was high for female patients when using AI-QCT ISCHEMIA compared to SPECT (91% vs. 68%, P  = 0.042). Area under the receiver operating characteristic curves were similar between both modalities (0.81 for AI-CCTA, 0.75 for SPECT, P  = 0.526). When comparing both modalities, the correlation coefficient was r  = 0.71 ( P  < 0.04).

CONCLUSION

AI-powered CCTA is a viable alternative to SPECT for detecting myocardial ischemia in patients with low- to intermediate-risk coronary artery disease, with significant positive and negative correlation in results. For patients who underwent confirmatory invasive angiography, the results of AI-CCTA and SPECT imaging were comparable. Future research focusing on prospective studies involving larger and more diverse patient populations is warranted to further investigate the benefits offered by AI-driven CCTA.