Coronary computed tomography angiography plaque and flow patterns in acute coronary syndrome lesions

Acute coronary syndrome (ACS) risk stratification requires assessment across different time frames. This multicenter study investigated whether a single coronary computed tomography angiography (CCTA) scan could provide integrated short-term (≤7 days) and long-term (≥30 days) risk assessment. The study developed and validated dual-timeframe models combining population health data, stenosis severity, quantitative low-density plaque burden (LDP%), and the hemodynamic parameter ΔCT-FFR (CT-derived fractional flow reserve [CT-FFR] proximal to the lesion minus CT-FFR distal to the lesion). Key findings indicate that while stenosis and LDP% predicted ACS risk in both time frames, ΔCT-FFR was specifically associated with short-term risk. The combined models demonstrated superior performance and greater net clinical benefit compared to using stenosis severity alone, as confirmed in multiple external cohorts. These results establish that a single CCTA examination can simultaneously assess immediate and future ACS risk.

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Publication Details

Journal
iScience
Published
2025-11-05
DOI
https://doi.org/10.1016/j.isci.2025.113821
Primary Topic
Cardiac Imaging and Diagnostics
Type
article
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article

Coronary computed tomography angiography plaque and flow patterns in acute coronary syndrome lesions

Jun Hua Guo, Zhi Xu, Long Jiang Zhang, Ying Han et al.
iScience
Cardiac Imaging and Diagnostics
article

Coronary computed tomography angiography plaque and flow patterns in acute coronary syndrome lesions

Jun Hua Guo, Zhi Xu, Long Jiang Zhang, Ying Han, Liyun Miao, Xin Wei Tao, Peng Xu, Hui Xu, Feng Wang, Qian Chen, Fan Zhou, Hong Qiao, Xi Hu, Chang Sheng Zhou, Meng Jie Lu, Ya Liu, Bang Jun Guo, Jia Ni Zou
article en

Abstract

Acute coronary syndrome (ACS) risk stratification requires assessment across different time frames. This multicenter study investigated whether a single coronary computed tomography angiography (CCTA) scan could provide integrated short-term (≤7 days) and long-term (≥30 days) risk assessment. The study developed and validated dual-timeframe models combining population health data, stenosis severity, quantitative low-density plaque burden (LDP%), and the hemodynamic parameter ΔCT-FFR (CT-derived fractional flow reserve [CT-FFR] proximal to the lesion minus CT-FFR distal to the lesion). Key findings indicate that while stenosis and LDP% predicted ACS risk in both time frames, ΔCT-FFR was specifically associated with short-term risk. The combined models demonstrated superior performance and greater net clinical benefit compared to using stenosis severity alone, as confirmed in multiple external cohorts. These results establish that a single CCTA examination can simultaneously assess immediate and future ACS risk.

iScienceVol. 28(12)
Ningbo University (CN), Jiangnan University (CN), Nanjing General Hospital of Nanjing Military Command (CN), Sir Run Run Shaw Hospital (CN), Boston Scientific (United States) (US), Central Hospital of Wuhan (CN), Wuhan General Hospital of Guangzhou (CN), Siemens Healthcare (United States) (US), Southern Medical University (CN), Zhejiang University (CN), Nanjing Medical University (CN), Nanjing University (CN)
Openalex Percentile: Top 53%
Cardiac Imaging and Diagnostics
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