State of the Art Cleerly Coronary Analysis To Detect Artery Plaque
by Mila McManus MD
Our medical providers often refer patients for coronary artery calcium [CAC] scans which are used to detect and quantify atherosclerosis [hardened and calcified plaque]. There have been several peer reviewed papers, including ICONIC, PROMISE, and SCOT-HEART, confirming that accumulation of plaque within the arteries is the strongest predictor of a heart attack.
The healthcare system misses more than half of patients who appear to be the picture of health but suffer a heart attack. In other words, more than half of the people who suffer from a heart attack do so without any symptoms!  Though a CAC scan is affordable and significantly more informative than a stress test, even the CAC scan misses the buildup of non- calcified plaque. More alarming is that 70% of heart attack victims are considered low risk by traditional methods of assessing heart disease.  Conventional methods are only identifying a small portion [30%] of people who could have a heart attack at any moment. Stress testing, one of the most conventional methods, misses 75% of the lesions responsible for heart attacks. 
Researchers have found that there is more than one kind of plaque, some creating a higher risk for heart disease than others. The more immediate risk lies in softer, non-calcified plaque which is not detected through the CAC scan. The good news, however, is that through a newer, state of the art non-invasive coronary computed tomography angiography, or CCTA analysis with Cleerly artificial intelligence technology, these higher risk plaques can be identified. The CCTA+Cleerly analysis is the first approach that may truly prevent heart attacks by detecting the largest predictor of heart attacks: the high risk soft plaque. This analysis has proven superior to the CAC scan over 2, 5, and 10 year periods in one study. 
While our practitioners will continue to encourage our patients to get the CAC scan for its affordability and increased insight to potential disease that cannot be determined by a stress test, we are very excited about the CCTA analysis through Cleerly Health. While more costly, the analysis can provide more precise and comprehensive information needed to prevent a heart attack. The CAC scan cannot detect and quantify low-density, non-calcified plaque, which is more likely than hardened and calcified plaque to rupture and cause a potentially fatal blood clot. Furthermore, several studies have concluded that the CCTA+Cleerly analysis shows coronary atherosclerosis in 41-53% of patients with a CAC score of zero. CCTA+Cleerly analysis also provides physicians with calcium scoring, making the CAC scan unnecessary when the CCTA analysis is used.
Be proactive. Be Well.
 Coronary Atherosclerotic Precursors of Acute Coronary Syndromes. Journal of the American College of Cardiology. June 5, 2018.
 Prognostic Value of Coronary CTA in Stable Chest Pain: CAD-RADS, CAC, and Cardiovascular Events in PROMISE. Journal of the American College of Cardiology. July 13, 2020.
 SCOT-HEART Trial: Reshuffling Our Approach to Stable Ischemic Heart Disease. British Journal of Radiology. September 1, 2020.
 Benjamin E.J. et al. Circulation 2019.
 Chang, H.J. et al. Journal of American College of Cardiologists. 2018.
 Akosah K.O. et al. Journal of American College of Cardiology. 2003.
 Nurmohamed, N.S. et al. AI-Guided Plaque Staging Predicts Long-Term CVD. JACC: Cardiovascular Imaging. 2023.
 The Fallacy of the Power of Zero. Journal of the American College of Cardiology: Cardiovascular Imaging. June 2022.