Impact of Atherosclerosis Imaging-Quantitative Computed Tomography on Diagnostic Certainty, Downstream Testing, Coronary Revascularization and Medical Therapy: The CERTAIN Study

Document Type

Journal Article

Publication Date



European heart journal. Cardiovascular Imaging




AIMS: The incremental impact of Atherosclerosis Imaging-Quantitative Computed Tomography (AI-QCT) on diagnostic certainty and downstream patient management is not yet known. The aim of the present study was to compare the clinical utility of routine implementation of AI-QCT versus conventional visual coronary CT angiography (CCTA) interpretation. METHODS AND RESULTS: In this multicenter crossover study in 5 expert CCTA sites, 750 consecutive adult patients referred for CCTA were prospectively recruited. Blinded to the AI-QCT analysis, site physicians established patient diagnosis and plans for downstream non-invasive testing, coronary intervention and medication management based on the conventional site assessment. Next, physicians were asked to repeat their assessments based upon AI-QCT results. The included patients had an age of 63.8 ± 12.2 years, 433 (57.7%) were male. Compared to conventional site CCTA evaluation, AI-QCT analysis improved physician's confidence 2-5-fold at every step of the care pathway and was associated with change in diagnosis or management in the majority of patients (428; 57.1%; p < 0.001), including for such measures as Coronary Artery Disease-Reporting and Data System (CAD-RADS) (295; 39.3%; p < 0.001) and plaque burden (197; 26.3%; p < 0.001). After AI-QCT including ischemia assessment, the need for downstream non-invasive and invasive testing was reduced by 37.1% (p < 0.001), compared with the conventional site CCTA evaluation. Incremental to the site CCTA evaluation alone, AI-QCT resulted in statin initiation/increase an aspirin initiation in an additional 28.1% (p < 0.001) and 23.0% (p < 0.001) of patients, respectively. CONCLUSIONS: Use of AI-QCT improves diagnostic certainty, and may result in reduced downstream need for non-invasive testing and increased rates of preventive medical therapy.