Evidence map›Paper›PMID 41906604›Full record

ArticleJACC. Advances2026

AI-Driven Quantitative Coronary CT Angiography in Suspected Coronary Artery Disease: Multicenter CONFIRM2 Registry.

Alexander van Rosendael, Rine Nakanishi, Jeroen J Bax, Gianluca Pontone, Saima Mushtaq, Ronny R Buechel, Christoph Gräni, Gudrun Feuchtner, Pietro G Lacaita, Amit R Patel and 47 more

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Article in JACC. Advances, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

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

Who cites it

2 citing papers in PubMed.

  1. Review
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

57 authors.

Alexander van RosendaelDepartment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
Rine NakanishiDepartment of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan.
Jeroen J BaxDepartment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
Gianluca PontoneDepartment of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy.
Saima MushtaqPerioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy.
Ronny R BuechelDepartment of Nuclear Medicine, Cardiac Imaging, University Hospital and University of Zurich, Zurich, Switzerland.
Christoph GräniDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Gudrun FeuchtnerDepartment of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
Pietro G LacaitaDepartment of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
Amit R PatelDivision of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA.
Cristiane C SingulaneDivision of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA.
Andrew D ChoiDepartment of Cardiology and Radiology, George Washington University, Washington, DC, USA.
Mouaz Al-MallahDepartment of Cardiology, Houston Methodist, Houston, Texas, USA.
Daniele AndreiniDivision of University Cardiology, IRCCS Galeazzi Sant'Ambrogio, Department of Biomedical and Clinical Sciences, University of Milan, Italy.
Ronald P KarlsbergCardiovascular Research Foundation of Southern California, California, USA; David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Geoffrey W ChoCardiovascular Research Foundation of Southern California, California, USA; David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Carlos E RochitteHeart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Mirvat AlasnagCardiac Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.
Ashraf HamdanDepartment of Cardiology, Rabin Medical Center, Petach Tikva, Tel Aviv, Israel; Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Filippo CademartiriDepartment of Radiology, IRCCS SYNLAB SDN, Naples, Italy.
Erica MaffeiDepartment of Radiology, IRCCS SYNLAB SDN, Naples, Italy.
Hugo MarquesUNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Imaging Department, Católica Medical School, Lisbon, Portugal.
Pedro de Araújo GonçalvesUNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Imaging Department, Católica Medical School, Lisbon, Portugal; CHRC-Comprehensive Health Research Center, LA-REAL, NOVA Medical School, Lisbon, Portugal.
Himanshu GuptaCardiac Imaging, Heart and Vascular Institute, Valley Health System, Paramus, New Jersey, USA.
Martin HadamitzkyDepartment of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany.
Omar KhaliqueDivision of Cardiovascular Imaging, St. Francis Hospital and Heart Center, Roslyn, New York, USA.
Dinesh KalraDivision of Cardiology, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA.
James D MillsDepartment of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA.
Nick S NurmohamedDepartment of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Paul KnaapenDepartment of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Matthew BudoffThe Lundquist Institute, Torrance, California, USA.
Kashif ShaikhUniversity of Tennessee Medical Center, Knoxville, Tennessee, USA.
Enrico MartinDivision of Cardiology, MercyOne-Iowa Heart Center, Des Moines, Iowa, USA.
David M GermanKnight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA.
Maros FerencikKnight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA.
Andrew C OehlerAllegheny Health Network Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, United States of America.
Roderick DeañoDepartment of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Prashant NagpalDepartment of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Marly van AssenDepartment of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA.
Carlo N De CeccoDepartment of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA.
Vasileios Kamperidis1st Cardiology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Borek FoldynaDepartment of Radiology, Cardiovascular Imaging and Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Jan M BrendelDepartment of Radiology, Cardiovascular Imaging and Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Victor Y ChengMinneapolis Heart Institute, Minneapolis, Minnesota, USA.
Kelley R BranchDivision of Cardiology, Cardiovascular Clinical Trials, University of Washington, Seattle, Washington, USA.
Marcio BittencourtHeart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Sabha BhattiNational institute of Cardiovascular Diseases, Karachi, Pakistan.
Venkateshwar PolsaniPiedmont Heart Institute, Atlanta, Georgia, USA.
George WesbeyDepartment of Cardiovascular Computed Tomography, Scripps Clinic, La Jolla, California, USA.
Rhanderson CardosoDivision of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Ron BlanksteinDivision of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Augustin DelagoMedical Data Research Collaborative, London, England, United Kingdom; Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts, USA.
Amit PursnaniCardiology, Endeavor NorthShore Cardiovascular Institute, Evanston, Illinois, USA; University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA.
Amro AlsaidDepartment of Cardiac Imaging, Baylor Scott and White, The Heart Hospital Plano, Plano, Texas, USA.
Stephen BloomMidwest Heart & Vascular Associates, Kansas City, Missouri, United States of America.
Melissa AquinoCleerly, Inc., Denver, Colorado, USA.
Ibrahim DanadDepartment of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands. Electronic address: ibrahim.danad@radboudumc.nl.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPlaque assessment by quantitative coronary CT angiography has demonstrated to correlate highly with intravascular ultrasound and optical coherence tomography, and these modalities have shown strong prognostic value.

objectivesThe purpose of this study was to identify the prognostic value of artificial intelligence-guided quantitative CCTA (AI-QCT) for major adverse cardiovascular events (MACE) against the risk factor-weighted clinical likelihood model.

methodsThe CONFIRM2 (COroNary CT Angiography Evaluation For Evaluation of Clinical Outcomes: An InteRnational, Multicenter Registry) is a multicenter, international, observational cohort study that included patients with clinically indicated CCTA and follow-up for MACE. Patients without cardiac symptoms and prior coronary artery disease (CAD) were excluded. Across the entire coronary artery tree, the presence, extent, and composition of CAD were analyzed by an AI-QCT software, and 24 variables at a patient, vessel, and plaque level were derived, including percent luminal narrowing, remodeling index, plaque volumes (total, calcified, noncalcified, low attenuation), and plaque composition. The primary MACE endpoint was defined as a composite of all-cause death, myocardial infarction (MI), stroke, congestive heart failure, late revascularizations, and hospitalization for unstable angina. The secondary MACE endpoint was defined as all-cause death and MI.

resultsA total of 3,551 patients (age 58.8 ± 12.5 years, 50.5% male) were followed for a median of 4.27 (IQR: 3.47-5.08) years during which 167 (4.7%) events occurred. After excluding collinear variables, diameter stenosis (HR: 1.25 [95% CI: 1.18-1.32]) per 10% increase and noncalcified plaque volume (HR: 1.07 [95% CI: 1.03-1.11]) per 50 mm

conclusionsThis first multicenter global registry with AI-guided quantitative CT identified noncalcified plaque burden and increment in stenosis severity as the most powerful predictors of MACE, demonstrating the interplay between traditional and novel measures of the severity of CAD. Standardized and rapid quantitative assessment of CAD may improve clinical implementation of multidimensional assessment of CAD as a cornerstone for risk assessment.

Indexed as

artificial intelligencecoronary artery diseasecoronary CTnoncalcified plaque volumeplaque quantificationquantitative coronary CTrisk stratificationtotal plaque volume

Identifiers

PMID41906604
PMCPMC13352004

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