COMBINE-CT

In coronary artery disease (CAD), plaques made up of fat and calcium build up in the arteries, gradually narrowing them and blocking the flow of blood to the heart. It affects around 5% of people in the EU and is a leading cause of death.

According to current clinical guidelines in the EU, UK and US, patients suspected of having CAD should first have a scan called a coronary computed tomography angiography (CCTA). CCTA is non-invasive and uses X-rays and computer processing to create a detailed 3D image of the coronary arteries. It therefore allows doctors to accurately assess how blocked a patient’s arteries are and helps to determine whether the patient needs an invasive procedure such as an operation to manage their condition or if medication would be enough.

In practice, challenges with interoperability across systems, devices, and geographies mean that CCTA is not being used to its full potential. As a result, an estimated 60% of patients still undergo invasive tests such as invasive coronary angiography (ICA) for CAD unnecessarily. In an ICA, a catheter is inserted into the blood vessels at the groin or arm and guided to the heart area where it releases a contrast medium that shows up on X-rays.

The goal of the COMBINE-CT project is to deliver an automated CCTA-enabled workflow that will improve and connect the different steps in the care of CAD patients, ranging from diagnosis to treatment planning, treatment procedure, and follow-up. Artificial intelligence (AI) powered algorithms will make it easier than ever to definitively diagnose CAD, select the right treatment for the right patient, plan interventions, use this information during an invasive procedure, and ensure patients are followed up appropriately.

The project brings together experts in cardiology, imaging, surgery, and artificial intelligence as well as health economists and patient organisations. Together, they will carry out five multi-centre studies to generate evidence on the benefits of computed tomography (CT) scans across the CAD care pathway. Among other things, these studies will investigate the value of CT for definitive CAD diagnosis, treatment planning and support, and explore how a technique called photon counting spectral CT can be used to evaluate coronary artery bypass grafts and previously implanted stents.

While COMBINE-CT focuses on heart disease, the project hopes that its findings will also prove useful to other disease areas where CT scans are widely used.