🫀📊 Quantitative Coronary Plaque Analysis (QCPA): where do we really stand?
The 2025 ACC Scientific Statement provides the most balanced and pragmatic framework to date on how AI-enabled quantitative coronary plaque analysis (QCPA) should—and should not—be used in clinical practice .
🚀 Why QCPA matters
Advances in coronary CTA, AI segmentation, and detector technology now allow objective, volumetric quantification of plaque burden (total, calcified, non-calcified). Beyond stenosis severity, plaque burden—especially non-calcified and low-attenuation plaque—has strong prognostic relevance, particularly in patients without obstructive CAD. QCPA offers the promise of more personalized preventive care.
⚠️ But reality check
The statement is refreshingly cautious. While correlations with invasive imaging are strong for total plaque volume, accuracy drops for smaller plaque components, and inter-vendor variability remains substantial. Overcalling subvisual plaque is a real risk, especially in low-risk patients, potentially leading to anxiety and overtreatment. Importantly, there is still no definitive evidence that QCPA improves hard clinical outcomes.
📌 Key clinical takeaways
✅ QCPA may be useful only when plaque is visually present on coronary CTA, to refine risk stratification and guide preventive therapy intensity.
❌ QCPA should not be reported in isolation or when visual plaque is absent (CAD-RADS 0).
👩⚕️ Human oversight is mandatory: physicians must review raw images and AI outputs.
📄 Reports must be standardized (TPV, NCPV, CPV, segments analyzed, comparison with prior scans).
🔁 Serial imaging? Use with restraint
Routine serial QCPA is not recommended. If performed, it should be in select cases, with long intervals (≥2–5 years), identical protocols, and cautious interpretation of progression thresholds.
🔮 The road ahead
Standardization, cross-vendor validation, outcome-anchored thresholds, and integration into trials are essential. QCPA is a powerful tool—but only when used expertly, selectively, and responsibly.