AI Predicts Heart Attack Risk in Angina Patients with HeartFlow
An innovative artificial intelligence-based tool, HeartFlow, utilizing CT-derived fractional flow reserve (FFR-CT), has demonstrated significant potential in predicting future major adverse cardiovascular events (MACE) in patients experiencing angina. Presented at EACVI 2025, a sub-analysis of the pivotal PROMISE trial revealed that FFR-CT, which non-invasively analyzes coronary computed tomography angiography (CCTA) images to estimate blood flow restrictions, provides crucial prognostic information beyond traditional CCTA findings.
The study highlighted that patients with an abnormal FFR-CT score (≤0.80) faced a substantially higher risk of MACE over five years, with a hazard ratio of 1.77, irrespective of the severity of coronary artery stenosis observed on CCTA. This elevated risk was evident even in individuals with intermediate stenosis (50-70%) or non-obstructive coronary artery disease (CAD, <50% stenosis) if their FFR-CT results indicated functional impairment. This finding underscores a critical benefit: HeartFlow can identify high-risk patients who might otherwise be underestimated by anatomical assessments alone, enabling earlier and more targeted interventions.
The primary benefit of this AI-powered approach lies in its ability to enhance risk stratification and guide treatment decisions for angina patients. By pinpointing those at increased risk of heart attacks or other serious cardiovascular events, clinicians can implement more aggressive preventive strategies or consider timely interventions, potentially improving patient outcomes and avoiding unnecessary invasive procedures. HeartFlow offers a non-invasive method to assess the functional significance of coronary blockages, providing a more comprehensive understanding of a patient's cardiovascular health.
While the technology offers immense promise, considerations include its cost, availability, and the need for continued integration into clinical workflows. Although FFR-CT itself is an analytical tool, the underlying CCTA involves radiation exposure. However, the incremental prognostic value of FFR-CT, independent of conventional risk factors, positions it as a valuable asset in the evolving landscape of precision cardiology, empowering clinicians to make more informed decisions for individuals living with angina.
