Paul Dudley White lecturer outlines profound tech impact on coronary care
AI, imagenomics and robotics could redefine how physicians assess cardiovascular risk and treat disease.
Imagine a future where patient care relies less on invasive procedures while artificial intelligence, advanced imaging and precision medicine improve outcomes. It’s not far away, according to Patrick Serruys, MD, PhD, eFESC, FACC, who headlines this year’s Paul Dudley White International Lecture and Session.
Serruys, a professor of interventional medicine and innovation at the University of Galway in Ireland, will draw on his research to present a bold forecast for coronary revascularization. His presentation, “Paul Dudley White Lecture: Coronary Revascularization in 2040,” is part of the Global Impact Program at Scientific Sessions.
At the center of this technological transformation is a rapidly emerging discipline known as imagenomics (“image-nomics”), he said, which combines medical imaging with genomic, proteomic, lipidomic and metabolomic data to identify cardiovascular risk earlier and tailor treatment strategies to each patient.
“Having forecasted in 2000 the impact of innovations like drug-eluting stents, coronary computed tomography angiography and bioresorbable scaffolds, our research examined the evolving landscape of coronary artery disease treatment, emphasizing artificial intelligence and omics sciences,” Serruys said. “Imagenomics — the integration of imaging and omics — will be a transformative tool, with AI enabling more personalized decisions between pharmacological and mechanical revascularization.”
Serruys said cardiovascular care will expand beyond the measure of arterial blockages. It will shift to focus on biological risk. AI-powered analysis of genetic and imaging data will be a valuable tool for identifying patients at risk of developing coronary artery disease years before symptoms appear, he said.
“With novel biomimetic peptides like CD31 covalently bound to metallic or polymeric implanted devices, current antiplatelet and anticoagulant therapies will become obsolete,” Serruys said. “Advances in photon-counting computed tomography and Fiber Optic RealShape promise high-resolution imaging with lower radiation, enhancing procedural safety and diagnostic accuracy. It is anticipated that robotics and 3D holograms in percutaneous and surgical revascularization will improve precision and resulting outcomes.”
Large-scale research initiatives, including the UK Biobank Pharma Proteomics Project, the All of Us Research Program and the China Kadoorie Biobank, are creating the datasets needed for predictive and personalized cardiovascular medicine. Based on ongoing research, Serruys said he believes that future treatment decisions may increasingly favor pharmacological revascularization, where advanced drugs reverse plaque buildup and restore coronary function without surgical intervention.
Serruys said his research also addresses the predictive feature that coronary CT angiography will deliver as a comprehensive “one-stop shop” diagnostic platform by 2040. Physicians may use a single noninvasive scan to assess anatomy, blood flow, plaque characteristics and treatment options before deciding whether a patient needs medication, stenting or bypass surgery, he said.
One of the most significant forecasts, Serruys said, involves a shift away from traditional coronary stents. Instead, younger patients with soft, noncalcified plaque may increasingly be treated with powerful anti-atherosclerotic medications that would regress plaque, reducing the need for mechanical interventions.
Also, Serruys said next-generation bioresorbable scaffolds, drug-coated balloons and innovative bioadaptors are expected to advance medicine’s goal of “leaving nothing behind” after treatment. Unlike permanent metal stents, he said, these devices would gradually dissolve or restore natural vessel function over time.
“The aging population will drive demand for mechanical interventions, with advancements in atherectomy and lithotripsy techniques improving outcomes in complex, calcified lesions,” Serruys said. “Our analysis outlines a future where myocardial revascularization becomes increasingly personalized, with technology-driven interventions redefining cardiovascular medicine.”
Finally, Serruys said robotic-assisted procedures are likely to play a larger role by 2040. His research highlights the potential benefits of robotic percutaneous coronary intervention, including improved procedural precision, lower physician radiation exposure and future possibilities for remote intervention. Similar advances are occurring in robotic cardiac surgery, where minimally invasive procedures continue to gain momentum.
But he cautioned that high costs, technical limitations and training requirements will remain barriers to widespread adoption.
“In the future, cardiology clinics will likely resemble a technology-enabled precision medicine center, where disease is predicted, prevented and treated before major cardiac events occur,” Serruys said.
"Dr. Paul Dudley White is widely regarded as a pioneer of preventive cardiology. He was a staunch advocate that lifestyle plays a critical role in the development and prevention of coronary artery disease,” Serruys added. “As a retired interventional cardiologist, I wholeheartedly embrace his vision. I believe the future of cardiovascular medicine lies in imagenomics and early prevention, combining a healthy lifestyle with potent, biomimetic antiatherogenic agents when lifestyle interventions alone are insufficient.”
