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Predicting Acute Myocardial Infarction in the Absence of Detectable Atherosclerotic Plaque With Perivascular Coronary
David A Hinchman1, Jennifer Woodburn1, Daniel K Noonan1
1High Desert Heart and Vascular, PLLC, Meridian, Idaho, USA.
Insights
Artificial intelligence analysis of coronary computed tomography angiography (CTA) can identify coronary artery disease risk. Severe perivascular inflammation, detected by AI using the fat attenuation index (FAI), predicts cardiac events even without visible plaque.
Area of Science:
- Cardiology
- Radiology
- Artificial Intelligence
Background:
- Coronary computed tomography angiography (CTA) with artificial intelligence (AI) analysis aids in personalizing coronary artery disease (CAD) risk stratification.
- Traditional risk stratification methods may not fully capture the risk associated with subclinical inflammation.
Background:
Coronary computed tomography angiography (CTA) with analysis by artificial intelligence (AI) can personalize coronary artery disease risk stratification.
Case Summary:
A 61-year-old man with coronary artery disease risk factors sought risk stratification admitting to exertional dyspnea. Coronary CTA revealed no plaque in the left circumflex coronary artery (LCx) by visual or AI analysis, but severe perivascular coronary inflammation was measured using the fat attenuation index (FAI) in the 99th percentile for age and gender. He had a non-ST-segment elevation myocardial infarction 96 days later due to occlusion of the LCx obtuse marginal branch.
Discussion:
Perivascular coronary inflammation assessed by AI analysis of coronary CTA is predictive of adverse coronary events even in the absence of identifiable coronary plaque.
Take-Home Messages:
A highly inflamed fatty streak in the coronary endothelium of the LCx capable of acutely occluding the coronary artery was invisible to artificial intelligence-guided quantitative computed tomography, yet left a clear radiomic signature of alarming vascular inflammation described in FAI. Perivascular FAI on coronary CTA can noninvasively personalize the risk of major adverse cardiac events in the absence of detectable coronary plaque.
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