Artificial Intelligence for Preventing Heart Disease: Observational, Single Center, Prospective and Retrospective Study
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 3,000
- 试验地点
- 1
- 主要终点
- composite outcome 1
研究概览
简要总结
Coronary artery disease (CAD) is a leading cause of mortality in western countries. Coronary computed tomography angiography (cCTA) is the first-line imaging test in patients with suspected obstructive CAD. However, in most patients, cCTA shows non-obstructive CAD. The management of patients with non-obstructive CAD is unclear. This is due to the lack of cCTA-based methods capable to assess the risk of disease progression towards developing major adverse cardiovascular events (MACEs) based on the atherosclerosis characteristics of each patient. A solution for prognostication in these patients is particularly appealing since it could allow to identify patients who can benefit of a more aggressive medical treatment and management, thus improving outcome.
Proposed methods, which include qualitative evaluations such as the identification of adverse atherosclerotic plaque characteristics or quantitative evaluations such as the quantification of atherosclerotic plaque burden, may in some cases suffer of limited reproducibility between operators and software. Most importantly, each single biomarker is insufficient to accurately predict patient risk, hence potential synergic integration of cCTA and clinical biomarkers is the key to efficiently guide the personalization of patient's management. Furthermore, the few risk stratification methods that have been proposed are not designed to work on platforms capable of deploying the solution to other clinical settings, promoting prospective or external validation
详细描述
Background and Rationale
In recent years, cCTA has become a crucial diagnostic tool for suspected CAD, recommended as the first-line test for patients with an intermediate pre-test probability of CAD by the European Society of Cardiology (ESC) guidelines and the American HeartAssociation (AHA) and Italian guidelines , because of the well-known high negative predictive value of cCTA in ruling out obstructive CAD. However, most patients have non-obstructive CAD.
While the management of patients with obstructive CAD is established, as it revolves around further diagnostic test for ischemia evaluation or upfront coronary artery revascularization, this is not the case for patients with non-obstructive CAD. However, these cohort of patients still has a significant risk of developing major adverse cardiovascular events (MACEs) that could be prevented by implementing adequate medical therapy.
To date, many approaches have been proposed to tackle this issue. However, these proposed solutions lack the ability to provide quantitative and reproducible results with a sufficiently strong predictive value, are often proposed as a stand-alone solution without the integration with multiple prognosticator imaging and clinical parameters, and are not delivered through platforms capable of providing external validation and easy integration in the clinical workflow. Among the proposed prognostic approaches, some are based on the qualitative evaluation of coronary artery plaque features, such as positive remodeling, low attenuation of the plaque, presence of spotty calcification, and "napkin ring" sign , which is subject to significant inter-reader variability.
Other approaches rely on quantitative methods for evaluating atherosclerotic burden based on the extent of coronary artery plaques and their characteristics, such as calcium density, number of lesions, regional distribution, plaque volume, non-calcified plaque volume etc.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Other
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients with cCTA performed for CAD assessment
排除标准
- •Refusal to participate in the study
- •Age <18 years old
- •Presence of other cardiovascular comorbidities (e.g. severe valvulopathies; non-ischemic cardiomyopathies; etc.)
结局指标
主要结局
composite outcome 1
时间窗: 36 months from CCTA examination
death by cardiovascular events or non-fatal myocardial infarction
次要结局
- composite outcome 2(36 months from CCTA examination)
研究者
Antonio Esposito
Professor
IRCCS San Raffaele