Using AI for personalised prediction of heart attack

The technology works by non-invasively quantifying the degree of inflammation in the arteries from the standard coronary CT angiograms, Antoniades explained. By uploading the patient’s scan on a cloud platform, clinicians can obtain the quantification of coronary inflammation. Additionally, this medical device combines that information with the coronary atherosclerotic plaque burden and the risk factors of the patient to generate the personalised absolute risk of the patient of having a fatal heart attack, thus informing treatment decisions. ‘By knowing which arteries are inflamed,’ the professor pointed out, ‘you can predict which artery is going to develop disease in the future and also tell which artery with disease is going to give a heart attack. Then you know which is the vulnerable plaque but, most importantly, who is the vulnerable patient that needs treatment.’

Developed over the last three years, the technology has been successfully used in a research setting in large prospective trials and has already received clearance by European regulators as a medical device under the new Medical Device Regulations (CE mark). It is now used in clinical practice in hospitals.

The AI approach will advance CCTA for chest pain investigation – a first line of investigation in the United Kingdom and increasingly so in the rest of Europe and the USA. However, in up to 80% of cases, the result will still come back negative, showing no significant sign of disease and the patient is discharged. ‘The new technology analyses all cases, with or without disease, and quantifies the inflammatory burden inside the arteries,’ Antoniades said. ‘Then it tells you whether this patient who has no disease will develop the disease in the next few years, or if a patient who has had minor disease is likely to have a heart attack because that minor disease is unstable and may lead to plaque rupture in the next 2-5 years.’ By identifying patients most at risk of future heart attacks, prescribing an inflammatory agent such as colchicine – shown to be effective in preventing heart attacks – or even initiation (or escalation) of statin treatments, can be implemented.