A heart attack occurs when a coronary artery becomes blocked, cutting off oxygen supply to the heart. Treatment usually involves angioplasty with stent placement, a procedure performed around 40,000 times annually in the Netherlands. Despite intervention, about 15% of patients experience another heart attack within two years. Now, a new approach combines imaging and artificial intelligence (AI) to identify weak arterial spots that could trigger recurrent events.

Researchers at Radboud University Medical Center (Nijmegen, Netherlands) have developed a method using a miniature camera inside coronary arteries to capture high-resolution images of vessel walls. This technique, called optical coherence tomography (OCT), employs near-infrared light to visualize the artery at microscopic detail. While OCT is already used to guide stent placement and reduce complications, physicians typically assess only the infarction site. By adding AI analysis, entire arteries can now be mapped for vulnerabilities.

In a study of 438 patients, arteries were examined using OCT and analyzed with a newly developed AI, with follow-up over two years. The AI detected vulnerable arterial spots as accurately as international gold-standard labs, but also predicted recurrent infarctions or death within two years more effectively. The study, published in the European Heart Journal, demonstrates that AI can reliably handle the large volume of images produced by OCT scans, surpassing manual interpretation limits.

By identifying high-risk plaques and their exact locations, physicians may one day tailor medication or place preventive stents before another heart attack occurs. The study suggests AI could transform OCT from a localized diagnostic tool into a comprehensive method for predicting cardiovascular risk. Researchers expect it will take several years before this approach is integrated into routine clinical practice, but the potential to improve patient outcomes is significant.

“This technique is already used in clinical practice to guide angioplasty and to check whether a stent has been placed correctly”, said Jos Thannhauser, lead investigator of the study. “It has been shown that OCT reduces the risk of new infarctions and complications. But in those cases, physicians only look at a very small part of an artery—the site of the infarction. Our study shows that this technique, combined with AI, has much greater potential to map entire vessels.”

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