There are several ways to assess coronary artery disease noninvasively by CT. The simplest way is the coronary artery calcium (CAC) score, which is a non-contrasted CT of the heart that delineates the amount of calcium in the coronaries (please refer to calcium score blog, Coronary Artery Calcium Scoring: Now Available at Astra Healthcare). The more advanced method is the coronary plaque analysis, which may be obtained by coronary computed tomography angiography (CCTA) with contrast in addition to AI-based quantification. This last method offers several key advantages over simple CAC scoring in assessing cardiovascular risk and are enumerated below:
1. Comprehensive plaque characterization
CAC scoring only detects calcified plaque, while CCTA-derived plaque analysis quantifies both calcified and non-calcified plaque. Non-calcified plaque is often more vulnerable to rupture and is a major contributor to acute events, so its inclusion improves risk stratification.
2. Superior prognostic accuracy
Large prospective studies show that models using CCTA-derived metrics have higher predictive accuracy for adverse cardiovascular outcomes. This means CCTA-based plaque burden better identifies patients at high risk of death or myocardial infarction (MI).
3. Earlier and more sensitive detection
CAC scoring is less sensitive to early or mixed plaque stages, whereas CCTA can detect mixed plaque and quantify burden before significant calcification occurs. This allows for earlier intervention in high-risk individuals. The diagnostic accuracy of a CAC score of 0 improves with age. A CAC score of 0 does not reliably exclude coronary plaque in younger individuals, whereas its utility is greater in older adults.
4. Potential for personalized risk stratification
By combining total plaque burden with plaque composition, CCTA-derived analysis can refine risk scores beyond traditional clinical risk factors, guiding tailored prevention or revascularization strategies.
At Astra Healthcare, we offer two of the leading plaque analysis AI software (Heartflow and Cleerly). Please do not hesitate to call and make an appointment for your CCTA.
