A summary statement: With the continuous advancement of AI technology, it has been widely applied in cardiovascular imaging. However, robust evidence regarding AI’s diagnostic efficacy of 50 % coronary stenosis remains limited. Our meta-analysis synthesizing studies on CCTA-based AI systems for diagnosing ≥ 50 % coronary stenosis revealed consistently high AUC and sensitivity at both patient and vessel levels, confirming AI’s substantial diagnostic capability for ≥ 50 % coronary stenosis, while …