REWRITE-CAD Protocol: Risk Evaluation With AI-CPA to Reduce Progression and Improve Lifetime Care for Patients With Known Coronary Artery Disease (REWRITE-CAD)

September 16, 2026 updated by: HeartFlow, Inc.

Risk Evaluation With AI-CPA to Reduce Progression and Improve Lifetime Care for Patients With Known Coronary Artery Disease

REWRITE-CAD is a prospective, randomized, multi-center trial assessing the management of asymptomatic participants with a history of PCI or MI who will undergo a blinded CCTA and be randomly assigned to either the test arm in which participants receive the unblinded results of Heartflow AI-CPA or the usual care arm in which participants are blinded to the AI-CPA results.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

The objective of the REWRITE-CAD trial is to assess changes in lipid lowering therapy over time in participants with a history of PCI or MI who undergo a blinded CCTA and are randomly assigned to either the test arm in which participants will undergo a blinded CCTA and receive the unblinded Heartflow AI-CPA results or the usual care arm in which participants will undergo a blinded CCTA with blinded AI-CPA results.

Study Type

Interventional

Enrollment (Estimated)

350

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • United States
    • North Carolina
      • Greensboro, North Carolina, United States, 27401

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. History of PCI (1 year - 5 years prior to Day 0) and/or history of MI (Type I or II) (1 year - 5 years prior to Day 0)
  2. Patients who do not exhibit symptoms suggestive of CAD
  3. No other clinical CCTA subsequent to MI/PCI but prior to screening
  4. eGFR >45 mL/min per most recent measurement within 90 days
  5. Willingness to comply with all aspects of the protocol including research CCTAs, lab draws, medication adherence assessments, attending all study visits, and the ability to comply with prescribed medications
  6. For a female participant of childbearing potential (those who have not been surgically sterilized), a pregnancy test must be performed with negative results known within 7 days prior to randomization
  7. Ability to provide informed consent
  8. Visible plaque in non-stented region on CCTA as assessed by CCTA core lab
  9. Acceptable CCTA quality per Heartflow acceptance criteria

Exclusion Criteria:

Non-imaging based

  1. Symptoms suggestive of CAD (e.g. stable angina or dyspnea on exertion)

  2. On PCSK9i and/or inclisiran at baseline

  3. Reduced left ventricular ejection fraction (LVEF) <35%, if known

  4. Prior coronary artery bypass graft (CABG)

  5. Prior stents in 2+ vessel territories

  6. Life expectancy less than 2 years due to non-CV comorbidities

  7. Enrolled in an investigational trial that involves a non-approved cardiac drug or device

  8. Previously evaluated with and/or in a trial which includes AI-CPA

  9. Any condition that might interfere with trial procedures or follow up visits

  10. LDL-C <70 mg/dL at baseline lab draw

  11. Active chemotherapy and/or radiation

    Imaging Based (all to be assessed by CCTA core lab)

  12. Left Main (LM) ≥50% stenosis on baseline CCTA

  13. Proximal LAD FFRct <0.75

  14. Total occlusions in major vessels and/or total occlusion in stent

  15. No visible plaque in non-stented segments on CCTA

  16. Incidental findings requiring immediate follow-up or management (e.g., Aortic dissection, findings suggestive of cancer, pulmonary embolism)

  17. Findings that require further imaging follow-up within 1 year (e.g., pulmonary nodules ≥6 mm)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: Usual Care Arm
Experimental: Unblinded AI-CPA Test Arm
Device: Heartflow Analysis

REWRITE-CAD will provide AI-CPA results

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Percentage of participants who initiate or intensify lipid-lowering therapy (LLT)
Time Frame: Enrollment to 90 days
Enrollment to 90 days

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Percentage of participants who initiate or intensify lipid-lowering therapy (LLT)
Time Frame: Enrollment through end of study at 21 months
Enrollment through end of study at 21 months
Percentage of participants who initiate or intensify cardiovascular disease prevention medication therapy
Time Frame: Enrollment through end of study at 21 months
Enrollment through end of study at 21 months
Time to intensification of LLT
Time Frame: Enrollment through end of study at 21 months
Enrollment through end of study at 21 months
% Undergoing lipid testing
Time Frame: Enrollment through end of study at 21 months
Enrollment through end of study at 21 months
LDL-C changes
Time Frame: Enrollment through end of study at 21 months
Enrollment through end of study at 21 months
Changes in Plaque Volumes
Time Frame: Enrollment through end of study at 21 months
Enrollment through end of study at 21 months
Referral to invasive coronary angiography (ICA) and coronary revascularization
Time Frame: Enrollment through end of study at 21 months
Enrollment through end of study at 21 months
Percentage of participants classified as high adherence on the 8-item Morisky Medication Adherence Scale (MMAS-8)
Time Frame: Enrollment through end of study at 21 months

Evaluated using the 8-item MMAS-8 questionnaire. Total scores range from 0 to 8, where higher scores indicate better adherence. High adherence is defined as achieving a score of 8, medium adherence as 6 to <8, and low adherence as <6.
Enrollment through end of study at 21 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

HeartFlow, Inc.

Collaborators

Avania

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

October 1, 2026

Primary Completion (Estimated)

October 1, 2027

Study Completion (Estimated)

April 1, 2029

Study Registration Dates

First Submitted

September 11, 2026

First Submitted That Met QC Criteria

September 16, 2026

First Posted (Actual)

September 22, 2026

Study Record Updates

Last Update Posted (Actual)

September 22, 2026

Last Update Submitted That Met QC Criteria

September 16, 2026

Last Verified

September 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CP-912-001

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

Yes

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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