BackgroundCurrent approaches for initial coronary artery disease (CAD) assessment rely on pretest probability (PTP) based on risk factors and presentations, with limited performance. Infrared thermography (IRT), a non-contact technology that detects surface temperature, has shown potential in assessing atherosclerosis-related conditions, particularly when measured from body regions such as faces. We aim to assess the feasibility of using facial IRT temperature information with machine learning for the prediction of CAD.MethodsIndividuals referred for invasive coronary angiography or coronary CT angiography (CCTA) were enrolled. Facial IRT images captured before confirmatory CAD examinations were used to develop and validate a deep-learning IRT image model for detecting CAD. We compared the performance of the IRT image model with the guideline-recommended PTP model on the area under the curve (AUC). In addition, interpretable IRT tabular features were extracted from IRT images to further validate the predictive value of IRT information.ResultsA total of 460 eligible participants (mean (SD) age, 58.4 (10.4) years; 126 (27.4%) female) were included. The IRT image model demonstrated outstanding performance (AUC 0.804, 95% CI 0.785 to 0.823) compared with the PTP models (AUC 0.713, 95% CI 0.691 to 0.734). A consistent level of superior performance (AUC 0.796, 95% CI 0.782 to 0.811), achieved with comprehensive interpretable IRT features, further validated the predictive value of IRT information. Notably, even with only traditional temperature features, a satisfactory performance (AUC 0.786, 95% CI 0.769 to 0.803) was still upheld.ConclusionIn this prospective study, we demonstrated the feasibility of using non-contact facial IRT information for CAD prediction.