A recent review of coronary artery disease diagnosis argues that angiographic stenosis alone is no longer sufficient for triage, as risk also depends on plaque burden and phenotype, inflammation, coronary physiology, microvascular integrity, and patient-level vulnerability. The paper concludes that AI-supported multimodality assessment — combining coronary CTA, CT-derived fractional flow reserve, intravascular imaging, and physiologic testing — is likely to drive more individualized Heart disease care.

Why It Matters To Your Practice

• Coronary angiography still defines anatomy and helps guide revascularization, but it can miss the broader biology that determines near-term risk.

• Patients with similar stenosis severity may have very different risk profiles depending on plaque characteristics, endothelial dysfunction, inflammation, thrombogenicity, and microvascular disease.

• For clinicians, that means CAD triage is shifting from a single-lesion view to a more comprehensive vulnerable-patient framework.

Clinical Implications

• Intravascular ultrasound and optical coherence tomography can add plaque-level detail, including vessel wall pathology and high-risk morphology.

• Fractional flow reserve and non-hyperemic pressure ratios help identify whether epicardial lesions are actually flow-limiting.

• Coronary CTA plus CT-derived fractional flow reserve can noninvasively assess anatomy, plaque features, perivascular inflammation, and functional significance.

• AI may help synthesize imaging, physiology, and clinical variables into patient-specific risk estimates and treatment planning.

Insights

• This is a paradigm review rather than a new validation trial, but its message is clear: the reference standard for CAD evaluation is broadening.

• The practical opportunity for AI is less about replacing clinicians and more about integrating multimodal data that are difficult to weigh consistently at the bedside.

• The likely future state is precision cardiovascular medicine focused on the vulnerable patient, not just the tightest narrowing.

The Bottom Line

• If your CAD workflow still treats percent stenosis as the main decision signal, it may undercapture clinically important risk.

• Expect increasing pressure to incorporate plaque biology, physiology, inflammation, and AI-assisted multimodal interpretation into routine triage and treatment decisions.