Medical imaging continues to improve at a breakneck pace, and now cardiovascular CT scanners are being equipped with artificial intelligence (AI). This newly added AI provides physicians the tools to identify coronary artery disease—plaque buildup in the blood vessels of the heart—in much greater detail, thereby decreasing the risk of heart attack, stroke, and sudden cardiac death.

Since February 2025, Jupiter Medical Center has offered AI-enabled analysis of coronary computed tomography angiography (CCTA). This CT scan not only identifies and quantifies plaque buildup in the heart’s arteries, but also the type—hard or soft. This is a significant advantage because some soft plaques have a higher risk of rupturing, which can lead to heart attacks and other medical emergencies.

“Having the AI system assist in interpreting the CCTA is incredibly helpful,” says Dr. Paul Cofnas, a board-certified interventional and diagnostic radiologist. “Now we have a better understanding of what a particular plaque is made of, which in turn allows are cardiovascular colleagues to tailor individual treatment plans.”

“With this information in hand, patients may be able to reduce their risk through lifestyle changes and medications,” Cofnas says. “These changes include eating a heart-healthy diet, engaging in regular exercise, maintaining a healthy weight, smoking cessation, managing stress, and using medications to control blood pressure or diabetes or to lower cholesterol.”

Coronary CTA studies may be recommended for several reasons by a health professional. Patients may experience chest pain, shortness of breath, or other symptoms their doctor may be concerned about. They may also have risk factors such as high cholesterol, diabetes, a history of tobacco use, or a family history of coronary artery disease.

After identifying these risk factors, physicians may order noninvasive tests such as a CT scan, stress test, or cardiac calcium score. While these are quite helpful in identifying plaque buildup and limitations in blood flow to the heart, they are not perfect. A key to prevention is knowing what a plaque is made of, Cofnas says, so that the treatment plan can be customized.

"The new AI software compares a newly discovered plaque with thousands of completed studies, resulting in an output that can be easily interpreted,” he explains. This leads to consistency in reporting, Cofnas says, rather than relying solely on a doctor’s interpretation of the results. “The technology is fantastic, a great tool to have in the toolbox,” he says. However, the technology still requires a physician’s analysis. “It’s not replacing doctors; it’s here to help us.” He adds that radiologists are responsible for interpreting anything visualized on the CCTA such as aortic aneurysms, blood clots that have traveled to the lungs, and potential lung nodules that, although rare, may be cancer.

About 10 percent of JMC’s CCTA scans were AI-enabled within the first few months of the technology being offered, and the number continues to grow.

JMC uses Food and Drug Agency-approved software made by Cleerly, which Cofnas calls “the leading company in the digital healthcare space for cardiovascular health.” The scan creates dozens of images, and Cleerly's analysis of the scan is completed in less than four hours—and sometimes in minutes.

Cofnas says the AI test results assist his cardiology colleagues. “It’s certainly important to know if there is a 50 percent or 60 percent stenosis (narrowing of the arteries) within the heart arteries. But with the AI software, which has analyzed millions of images, we can look even deeper to identify restricted blood flow. This information has been instrumental in decision making and treatment.”

Cleerly’s analyses are based on more than 10 million images from over 40,000 patients gathered during a 15-year period in multicenter clinical trials. The proprietary machine learning algorithms noninvasively measure atherosclerosis (plaque), stenosis, and the likelihood of ischemia (restricted blood flow). The AI tool creates a 3D model of a patient’s coronary arteries along with a comprehensive report for physicians to help develop personalized care plans.

Another benefit: when a patient is obtaining a Cleerly AI-enabled CTA coronary study for the first time, they can have their previous CCTA scan analyzed free of charge with AI, even if it was not done initially using the AI software.

Noncalcified Plaque

Plaque buildup in the arteries is either hard (calcified) or soft (noncalcified). Soft plaque is made up of cholesterol, fat, and other cellular debris. Soft plaque is potentially more dangerous because it can become dislodged and lead to a heart attack, stroke, or sudden death.

A heart-healthy diet, exercise, and stress management can help stabilize existing plaque. Medications such as statins which reduce cholesterol can also help stabilize soft plaque, making it less likely to rupture. Medical procedures such as cardiac catheterization, balloon angioplasty, and stent placement may also be considered by a health professional for treatment and management of plaque buildup.

Early detection and intervention are the keys to managing soft plaque.

Coronary Artery Disease

Coronary artery disease (CAD) is very common and occurs when plaque develops in the blood vessels, called the coronary arteries, that supply the heart. When blood flow to the heart is reduced, it’s called ischemia. When the buildup narrows the arteries significantly, it can cause heart failure (decreased pumping of blood by the heart), and symptoms such as shortness of breath, chest pain, or even sudden death.

For many people, plaque starts to build up during adolescence and worsens as they age.

Risk factors include: high LDL cholesterol, low HDL cholesterol, high blood pressure, family history, diabetes, smoking, and obesity. In men, the risk increases after age 45. In women, the risk increases after 55.

A healthy lifestyle combining good nutrition, weight management, physical activity, and stress reduction may reduce or delay CAD progression. Medications to control blood pressure and diabetes and to lower cholesterol may also be prescribed.

For many people, the Centers for Disease Control and Prevention (CDC) reports, “the first clue they have CAD is a heart attack.” But these are other symptoms, according to the CDC, to watch for:

• Angina (chest pain and discomfort)
• Weakness, light-headedness, nausea, or a cold sweat
• Pain or discomfort in the arms or shoulder
• Shortness of breath