TCT 2025 Late-Breaking Science: Quantitative Assessment of Non-Calcified Plaque Volume Drives Risk for Myocardial Infarction and Death

CONFIRM2 Registry Demonstrates Prognostic Value of AI-Based Plaque Characterization Beyond Stenosis Severity

Partner News | Published: Friday, October 31, 2025

---

Cleerly, a leader in artificial intelligence (AI)-based cardiovascular imaging, presented new, late-breaking science from the international CONFIRM2 Registry at the Transcatheter Cardiovascular Therapeutics (TCT) 2025 Conference at the Moscone Center in San Francisco, CA.

The study, "AI-Guided Quantitative Plaque Evaluation from CT to Identify Patients with Future Myocardial Infarction or Death," analyzed 6,550 symptomatic patients (48% male, mean age 59) over 4.4 years who underwent coronary computed tomography angiography (CCTA) with AI-based quantitative coronary CT analysis (AI-QCT) across international sites.

The findings indicated:

• Both non-calcified plaque (NCP) volume and diameter stenosis were powerful independent predictors of heart attack and death.
• Patients who experienced events had nearly five times higher NCP volumes compared to those without events (254 mm³ vs 53 mm³).
• Those in the highest tertile of NCP volume faced nearly double the risk of adverse outcomes (HR 1.93, 95% CI 1.02-3.66) when adjusted for maximal stenosis severity.

Notably, many events occurred in patients who did not have obstructive coronary artery disease, reinforcing the critical need to look beyond stenosis severity alone when assessing cardiovascular risk.

"These results challenge our traditional approach to cardiac risk assessment," said Alexander Van Rosendael, MD, PhD, the study's first author. "By identifying high-risk plaque features, particularly large non-calcified lesions, we can now detect vulnerable patients who would have been missed by conventional stenosis-focused evaluations."

The CONFIRM2 findings continue to highlight the value of AI-QCT technology in identifying patients with hidden disease, informing earlier intervention strategies, and helping enable more targeted therapeutic approaches. These results suggest that high-risk plaque features may represent important therapeutic targets for prevention and intervention, potentially transforming how clinicians approach cardiovascular risk stratification and management.

« Back