Deep learning to detect significant coronary artery disease from plain chest radiographs AI4CAD

Background: The predictive role of chest radiographs in patients with suspected coronary artery disease (CAD) is underestimated and may benefit from artificial intelligence (AI) applications. Objectives: To train, test, and validate a deep learning (DL) solution for detecting significant CAD based on chest radiographs.Methods: Data of patients referred for angina and undergoing chest radiography and coronary angiography were analysed retrospectively. A deep convolutional neural network (DCNN) was designed to detect significant CAD from posteroanterior/anteroposterior chest radiographs. The DCNN was trained for severe CAD binary classifi-cation (absence/presence). Coronary angiography reports were the ground truth. Stenosis severity of >= 70% for non-left main vessels and >= 50% for left main defined severe CAD.Results: Information of 7728 patients was reviewed. Severe CAD was present in 4091 (53%). Patients were randomly divided for algorithm training (70%; n = 5454) and fine-tuning/model validation (10%; n = 773). Internal clinical validation (model testing) was performed with the remaining patients (20%; n = 1501). At binary logistic regression, DCNN prediction was the strongest severe CAD predictor (p < 0.0001; OR: 1.040; CI: 1.032-1.048). Using a high sensitivity operating cut-point, the DCNN had a sensitivity of 0.90 to detect signif-icant CAD (specificity 0.31; AUC 0.73; 95% CI DeLong, 0.69-0.76). Adding to the AI chest radiograph inter-pretation angina status improved the prediction (AUC 0.77; 95% CI DeLong, 0.74-0.80).Conclusion: AI-read chest radiographs could be used to pre-test significant CAD probability in patients referred for suspected angina. Further studies are required to externally validate our algorithm, develop a clinically appli-cable tool, and support CAD screening in broader settings.