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Artificial Intelligence in Coronary Plaque Characterization: Clinical Implications, Evidence Gaps, and Future

Juthipong Benjanuwattra1, Cristian Castillo-Rodriguez2, Mahmoud Abdelnabi3

  • 1Division of Cardiology, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA.

Journal of Clinical Medicine
|January 28, 2026
PubMed

Insights

Artificial intelligence (AI) enhances coronary artery disease (CAD) plaque analysis for better risk assessment. AI models improve detection, segmentation, and quantification, aiding personalized cardiovascular care despite adoption challenges.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Artificial Intelligence

Background:

  • Coronary artery disease (CAD) is a leading cause of death, with plaque characteristics critical for outcomes.
  • Current plaque analysis methods suffer from variability and inefficiency.
  • Artificial intelligence (AI) offers automated solutions for coronary plaque assessment.

Purpose of the Study:

  • To review the role of AI in automated coronary plaque analysis.
  • To highlight AI's potential in improving CAD risk stratification and personalized management.
  • To identify barriers hindering AI adoption in cardiovascular care.

Main Methods:

  • Review of AI applications in coronary plaque detection, segmentation, quantification, and vulnerability assessment.
  • Analysis of AI-derived imaging biomarkers for predicting major adverse cardiovascular events.
  • Discussion of challenges to AI implementation in clinical workflows.

Main Results:

  • AI models demonstrate high accuracy in plaque analysis across various imaging modalities.
  • AI integration with clinical scores enhances cardiovascular event prediction.
  • AI-enhanced imaging shows promise for both invasive and non-invasive CAD evaluation.

Conclusions:

  • AI is a transformative tool for coronary plaque analysis, improving diagnostic accuracy and patient management.
  • Overcoming challenges like data heterogeneity, bias, and regulatory hurdles is crucial for widespread AI adoption.
  • AI-enhanced imaging is poised to become a vital adjunct in routine cardiovascular care.

Keywords:
artificial intelligenceatherosclerosiscoronary artery calciumcoronary artery diseasecoronary computed tomography angiographycoronary plaquecoronary plaque quantificationplaque characteristics

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