# Quantitative coronary calcification analysis for prediction of myocardial ischemia using non-contrast CT calcium scoring

arXiv: https://arxiv.org/abs/2605.21745 · HTML: https://mlsanity.com/paper/2605.21745/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 5 of its 27 references that are in the map.
- First posted on arXiv 20 May 2026.

## Builds on (most cited first, 5 of 5)

- [A Unified Approach to Interpreting Model Predictions](https://mlsanity.com/paper/1705.07874/) (2017)
- [XGBoost: A Scalable Tree Boosting System](https://mlsanity.com/paper/1603.02754/) (2016)
- [AI prediction of cardiovascular events using opportunistic epicardial adipose tissue assessments from CT calcium score](https://mlsanity.com/paper/2401.16190/) (2024)
- [Enhancing cardiovascular risk prediction through AI-enabled calcium-omics](https://mlsanity.com/paper/2308.12224/) (2023)
- [Pericoronary adipose tissue feature analysis in CT calcium score images with comparison to coronary CTA](https://mlsanity.com/paper/2401.15554/) (2024)

## Abstract (arXiv)

Non-contrast computed tomography calcium scoring (CTCS) is widely recognized as an effective tool for cardiovascular risk stratification. This study aimed to develop a novel machine learning framework for predicting myocardial ischemia from routine non-contrast CTCS scans using quantitative coronary calcium assessment. This study analyzed 1,375 patients who underwent both non-contrast CTCS and regadenoson stress cardiac positron emission tomography myocardial perfusion imaging within one year at University Hospitals Cleveland Medical Center. A total of 74 variables, including clinical variables, Agatston score, and calcium-omics features, were evaluated. Relevant features were identified using XGBoost with Shapley Additive exPlanations (SHAP). Predictive models were trained and evaluated using 5-fold cross-validation. Among 987 patients, 89 (9%) were positive for myocardial ischemia. The final model incorporated the Agatston score, eight calcium-omics features, and age. The proposed model achieved a precision of 98.9+/-3.0%, sensitivity of 79.2+/-8.4, and F1 score of 87.7+/-5.3%. The addition of calcium-omics features significantly improved predictive performance compared with models using clinical variables alone or clinical variables with the Agatston score (p<0.05). Interestingly, the number of calcified arteries, despite being the lowest-ranked feature based on SHAP analysis, showed the strongest association with myocardial ischemia in logistic regression analysis (odds ratio: 3.63, 95% confidence interval: 2.80-4.77, p<0.00001). We developed a machine learning approach for predicting myocardial ischemia using routinely acquired non-contrast CTCS scans. Calcium-omics features provided incremental predictive value beyond conventional risk factors and Agatston scoring and may support more accessible cardiovascular risk stratification.