Incremental Risk Prediction of Cardiac CTA-Derived Quantitative Atherosclerosis in the International ADVANCE Registry

Document Type

Conference Proceeding

Publication Date


Publication Title



Background: We sought to assess the incremental prognostic utility of AI-enabled quantitative coronary plaque assessment (AI-QCPA) beyond stenosis severity and FFRCT, for the prediction of late revascularization and MACE in the large prospective international ADVANCE registry.

Methods: 4737 participants were submitted for AI-QCPA evaluation. Total plaque volume (TPV), calcified plaque volume (CPV), non-calcified plaque volume (NCPV), and low attenuated plaque volume (LAPV) were quantified. In addition, total percent plaque volume (TPAV) and its components were calculated (PV/Vessel Volume * 100). Demographics, stenosis severity, lowest FFRCT, and Delta FFRCT were also recorded. To explore the relationship between plaque measures and MACE (death, myocardial infarction, and unplanned hospitalization leading to revascularization) and late revascularization (>90 days) we performed Kaplan Meier event free outcomes analyses following adjustments for stenosis severity, FFRCT and Delta FFRCT.

Results: AI-QCPA was available in 4430 subjects. Mean (SD) TPV was 542.4 ± 522.5 mm3. Optimal cutpoints of plaque metrics were predictive of MACE and/or late revascularization when adjusted-TPV (HR- 1.45 CI- 1.06-1.98; P=0.02); CPV (HR- 1.65 CI- 1.21- 2.26; p=0.002); NCPV (HR 1.43 CI- 1.02-1.99; P=0.04) and LAPV (HR- 2.23 CI 1.62-3.07; P=0.03 . Stronger risk prediction was achieved by plaque measures adjusted for vessel volume: TPAV (HR 1.92 CI 1.40- 2.64 P<0.001). This incremental risk discrimination of quantitative plaque measures remained significant as a predictor of MACE alone- TPV- (HR 1.84 CI 1.02- 3.29 P=0.04) TPAV (HR 3.33 CI- 1.85- 6.02 P<0.0001) (Figure 1).

Conclusions: In this large prospective international registry, AI-QCPA provided incremental risk discrimination for MACE and late revascularization beyond stenosis severity and FFRCT.




Suppl 1

First Page



American Heart Association Scientific Sessions, November 11-13, 2023, Philadelphia, PA