Physicians chime in: Coronary plaque staging offers more precise cardiac patient management

As precision cardiology continues to evolve, the integration of advanced coronary computed tomography angiography (CCTA) and AI-driven analysis is fundamentally changing how we assess and manage coronary artery disease (CAD). Moving beyond traditional risk factors and stenosis, the focus is increasingly shifting toward comprehensive plaque quantification. At the forefront of this shift is Heartflow Plaque Staging, a framework designed to use Total Plaque Volume (TPV) to personalize individual cardiac risk and guide targeted medical management.

Here is a closer look at how Heartflow Plaque Staging is leveraging TPV to stratify patient risk.

The Shift to Plaque-Based Risk Stratification

Historically, cardiologists have relied on a combination of clinical risk scores, ischemia testing, and stenosis severity to guide treatment. However, significant cardiovascular events frequently occur in patients with non-obstructive disease.

Heartflow Plaque Staging aims to bridge this gap by offering the most clinically validated tool for plaque-based risk stratification. Validated upon data from 23,000+ patients with up to 16 years of follow-up (FISH&CHIPS 8K clinical study and Mass General Brigham CCTA registry), the framework demonstrates that TPV is a critical independent predictor of future cardiac events. According to the studies, higher TPV stages are associated with statistically significant higher event rates—even after adjusting for stenosis, FFR_CT, and traditional clinical risk factors.^1,2

Actionable Insights: The DECIDE Registry and the Four Stages of Plaque

Identifying risk is only half the battle; acting on it is where clinical outcomes are won. The DECIDE Registry—the largest prospective registry focused on Plaque Analysis—is a landmark prospective study of ~22,000 patients at over 30 centers across the United States. DECIDE demonstrates how Heartflow Plaque Analysis with Plaque Staging empowers physicians with clinical insights that lead to real-world impact. This is the next step in preventive CAD management, where diagnostic precision drives confident treatment planning.³

Heartflow Plaque Staging stratifies patients into four distinct categories based on TPV¹:

• Stage 1: Mild (TPV: 1-100 mm³)
• Stage 2: Moderate (TPV: 101-250 mm³)
• Stage 3: Severe (TPV: 251-750 mm³)
• Stage 4: Extensive (TPV: >750 mm³)

Measurable Patient Impact

The integration of Heartflow Plaque Staging has demonstrated measurable patient impact. For the first time, modeled outcomes demonstrate that when management is guided by Heartflow’s staging framework, the risk of cardiovascular events can be substantially decreased.

Specifically, plaque-led management has been shown to drive an average 18.7 mg/dL decrease in LDL-C, which translates to an expected ~15% reduction in the risk of cardiac events.^2,3 By linking advanced imaging diagnostics directly to aggressive, stage-appropriate pharmacotherapy, health systems can move from reactive interventions to proactive disease stabilization.

1. Fairbairn et al. Poster Presentation AHA November 2025
2. Huck, D. M., et al., & Blankstein, R. (2026, March). AI-based coronary plaque analysis and adverse cardiovascular events: The Mass General Brigham CCTA registry [Abstract presentation]. American College of Cardiology’s 75th Annual Scientific Session & Expo (ACC.26), New Orleans, LA, United States.
3. Rinehart, et al. JACC Imaging 2026. doi: 10.1016/j.jcmg.2026.0 
4. Collins et al. Lancet 2016. DOI: 10.1016/S0140-6736(16)31357-5

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