{
  "abstract": "Introduction Most acute coronary syndromes (ACS) originate from coronary plaques that are angiographically mild and not flow limiting. These lesions, often characterised by thin-cap fibroatheroma, large lipid cores and macrophage infiltration, are termed ‘vulnerable plaques’ and are associated with a heightened risk of future major adverse cardiovascular events (MACE). However, current imaging modalities lack robust predictive power, and treatment strategies for such plaques remain controversial.Methods and analysis The PREDICT-AI study aims to develop and externally validate a machine learning (ML)-based risk score that integrates optical coherence tomography (OCT) plaque features and patient-level clinical data to predict the natural history of non-flow-limiting coronary lesions not treated with percutaneous coronary intervention (PCI). This is a multicentre, prospective, observational study enrolling 500 patients with recent ACS who undergo comprehensive three-vessel OCT imaging. Lesions not treated with PCI will be characterised using artificial intelligence (AI)-based plaque analysis (OctPlus software), including quantification of fibrous cap thickness, lipid arc, macrophage presence and other microstructural features. A three-step ML pipeline will be used to derive and validate a risk score predicting MACE at follow-up. Outcomes will be adjudicated blinded to OCT findings. The primary endpoint is MACE (composite of cardiovascular death, myocardial infarction, urgent revascularisation or target vessel revascularisation). Event prediction will be assessed at both the patient level and plaque level.Ethics and dissemination The PREDICT-AI study will generate a clinically applicable, AI-driven risk stratification tool based on high-resolution intracoronary imaging. By identifying high-risk, non-obstructive coronary plaques, this model may enhance personalised management strategies and support the transition towards precision medicine in coronary artery disease.",
  "authors": [
    {
      "affiliations": [
        "Azienda Ospedaliero–Universitaria Città della Salute e della Scienza di Torino, Turin, Italy"
      ],
      "name": "Francesco Bruno"
    },
    {
      "affiliations": [
        "Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy"
      ],
      "name": "Maddalena Immobile Molaro"
    },
    {
      "affiliations": [
        "Dipartimento di Ingegneria Meccanica e Aerospaziale, Politecnico di Torino, Turin, Italy"
      ],
      "name": "Michela Sperti"
    },
    {
      "affiliations": [
        "Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy"
      ],
      "name": "Francesco Bianchini"
    },
    {
      "affiliations": [
        "School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China"
      ],
      "name": "Miao Chu"
    },
    {
      "affiliations": [
        "Dipartimento di Ingegneria Meccanica e Aerospaziale, Politecnico di Torino, Turin, Italy"
      ],
      "name": "Camilla Cardaci"
    },
    {
      "affiliations": [
        "Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland"
      ],
      "name": "Wojciech Wańha"
    },
    {
      "affiliations": [
        "Medical University of Silesia, Katowice, UK"
      ],
      "name": "Pawel Gasior"
    },
    {
      "affiliations": [
        "Rivoli Hospital, Rivoli, Italy"
      ],
      "name": "Simone Zecchino"
    },
    {
      "affiliations": [
        "Rivoli Hospital, Rivoli, Italy"
      ],
      "name": "Marco Pavani"
    },
    {
      "affiliations": [
        "Dipartimento Cardio-Toraco-Vascolare, IRCCS Ospedale Policlinico San Martino, Genoa, Italy"
      ],
      "name": "Rocco Vergallo"
    },
    {
      "affiliations": [
        "UO Cardiologia, Azienda Ospedaliero–Universitaria di Ferrara Arcispedale Sant’Anna, Cona, Italy"
      ],
      "name": "Simone Biscaglia"
    },
    {
      "affiliations": [
        "Rivoli Hospital, Rivoli, Italy"
      ],
      "name": "Enrico Cerrato"
    },
    {
      "affiliations": [
        "Interventional Cardiology, Univ Piemonte Orientale, Alessandria, Italy"
      ],
      "name": "Gioel Gabrio Secco"
    },
    {
      "affiliations": [
        "University Hospital Maggiore della Carità, Novara, Italy"
      ],
      "name": "Marco Mennuni"
    },
    {
      "affiliations": [
        "Department of Cardiovascular, Respiratory, Nephrological and Geriatrical Sciences, University of Rome La Sapienza, Roma, Italy",
        "University of Rome La Sapienza, Rome, Italy"
      ],
      "name": "Massimo Mancone"
    },
    {
      "affiliations": [
        "Azienda Ospedaliero–Universitaria Città della Salute e della Scienza di Torino, Turin, Italy"
      ],
      "name": "Ovidio De Filippo"
    },
    {
      "affiliations": [
        "AOU Careggi, Florence, Italy"
      ],
      "name": "Alessio Mattesini"
    },
    {
      "affiliations": [
        "Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy"
      ],
      "name": "Paolo Canova"
    },
    {
      "affiliations": [
        "Azienda Ospedaliera Brotzu, Cagliari, Italy"
      ],
      "name": "Alberto Boi"
    },
    {
      "affiliations": [
        "Interventional Cardiology, PO S Andrea di Vercelli, Vercelli, Italy"
      ],
      "name": "Fabrizio Ugo"
    },
    {
      "affiliations": [
        "Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy"
      ],
      "name": "Roberto Scarsini"
    },
    {
      "affiliations": [
        "Faculty of Medicine and Surgery, University of Messina, Messina, Italy"
      ],
      "name": "Francesco Costa"
    },
    {
      "affiliations": [
        "Cardiology Department, Azienda Sanitaria Universitaria Giuliano Isontina Dipartimento ad Attività Integrata Cardiotoracovascolare, Trieste, Italy"
      ],
      "name": "Enrico Fabris"
    },
    {
      "affiliations": [
        "UO Cardiologia, Azienda Ospedaliero–Universitaria di Ferrara Arcispedale Sant’Anna, Cona, Italy"
      ],
      "name": "Gianluca Campo"
    },
    {
      "affiliations": [
        "Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland"
      ],
      "name": "Wojtek Wojakowski"
    },
    {
      "affiliations": [
        "Dipartimento di Ingegneria Meccanica e Aerospaziale, Politecnico di Torino, Turin, Italy"
      ],
      "name": "Umberto Morbiducci"
    },
    {
      "affiliations": [
        "Dipartimento di Ingegneria Meccanica e Aerospaziale, Politecnico di Torino, Turin, Italy"
      ],
      "name": "Marco Deriu"
    },
    {
      "affiliations": [
        "School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China"
      ],
      "name": "Shengxian Tu"
    },
    {
      "affiliations": [
        "Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy"
      ],
      "name": "Raffaele Piccolo"
    },
    {
      "affiliations": [
        "Azienda Ospedaliero–Universitaria Città della Salute e della Scienza di Torino, Turin, Italy"
      ],
      "name": "Fabrizio D'Ascenzo"
    },
    {
      "affiliations": [
        "Dipartimento di Ingegneria Meccanica e Aerospaziale, Politecnico di Torino, Turin, Italy"
      ],
      "name": "Claudio Chiastra"
    },
    {
      "affiliations": [
        "Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy"
      ],
      "name": "Francesco Burzotta"
    },
    {
      "affiliations": [],
      "name": "PREDICT-AI group"
    }
  ],
  "title": "Adverse cardiovascular events in coronary Plaques not undeRgoing pErcutaneous coronary intervention evaluateD with optIcal Coherence Tomography. The PREDICT-AI risk model",
  "uid": "ad495bf1-ff99-520d-99ae-1ba3b9d46c87"
}