Researchers from The University of Western Australia, working with medtech industry partners Artrya, have developed a new, fully automated AI algorithm that is more effective than current methods at predicting the risk of heart attack.
First author Dr Gavin Huangfu, from UWA's Medical School, Harry Perkins Institute of Medical Research and Fiona Stanley Hospital, said coronary artery calcium scoring had revolutionised the prevention of heart disease in those with no symptoms, but the way it was measured had inherent drawbacks.
"It does not account for the location of calcified plaques along the coronary arteries despite knowledge that disease near the start of the artery carries greater risk," Dr Huangfu said.
"Also, highly calcified plaques are assigned paradoxically higher risk, although are otherwise considered stable plaques and actually confer lower risk of cardiac events such heart attack or sudden death due to heart attack.
"Solutions to these flaws require analysis of each individual plaque, which is not feasible for a human investigator, but readily attainable using artificial intelligence."
The team found the algorithm, known as CAC-DAD score, was capable of measuring the burden of coronary calcification as well as each lesion's distance from the coronary artery origin and reclassifying highly dense plaque as low risk – all done with a single click.
"We found that the CAC-DAD score is more precise and effective than the standard Agatston score at predicting the risk of cardiac events, particularly around the time of surgery, in vulnerable populations," Dr Huangfu said.
"We also found the combined use of Agatston score and CAC-DAD score together further improved risk prediction, opening many possibilities for its clinical use."
Senior author Professor Girish Dwivedi, also from UWA's Medical School, said heart disease remained the leading cause of death in developed countries.
"The optimal treatment remains prevention, which relies on accurate risk stratification to identify those at greatest risk who should receive targeted and aggressive preventative measures," Professor Dwivedi said.
"Your calcium score is the single, greatest predictor for your risk of having a first heart attack and optimising its accuracy will have significant benefits for the management of your risk.
"The shift to personalised care is a necessity and requires personalised investigations on top of population-based clinical risk scores.
"The greatest benefit of calcium scoring is its wide ease of applicability and interpretation. Once validated in other studies, our simple, yet powerful output of the CAC-DAD score can be used to guide management of patients by all members of the medical community.
"From here, we look forward to examining and validating the predictive power of the CAC-DAD score in larger, international cohorts."
The project was made possible by the collaboration between UWA, Artrya Ltd, South Metropolitan Health Service, Harry Perkins Institute of Medical Research, Victor Chang Cardiac Research Institute, the University of Ottawa Heart Institute in Canda and international efforts from the Vision group.
