Value of Multi-Parameter Combined Application of CZT-SPECT and CCTA in Risk Stratification of Short-Term Myocardial Ischemic Events in Patients with Chronic Coronary Syndromes

Background: This study aimed to investigate the predictive value of the multi-parameter combined application of cadmium–zinc–telluride single-photon emission computed tomography (CZT-SPECT) and coronary computed tomography angiography (CCTA) for short-term myocardial ischemic events in patients with chronic coronary syndromes (CCS). Methods: A total of 205 CCS patients who underwent both CZT-SPECT and concurrent CCTA were retrospectively enrolled. A reversible ischemia indicator (summed difference score, SDS) from CZT-SPECT and an inflammatory marker (fat attenuation index, FAI) from CCTA were obtained. Short-term myocardial ischemic major adverse cardiovascular events (MACEs) were recorded. Cox regression assessed independent predictive value, while net reclassification improvement (NRI), integrated discrimination improvement (IDI), and Kaplan–Meier curves evaluated incremental predictive and risk stratification ability. Results: 19 myocardial ischemic MACEs occurred. SDS was an independent predictor (HR: 1.386; 95%CI: 1.032–1.861; p = 0.030). Adding FAI to the combination of clinical factors and SDS significantly improved prediction (NRI = 0.215, p = 0.037; IDI = 0.043, p = 0.017). The high-SDS plus high-FAI group had the highest event rates (20.0%, all p < 0.05). Conclusions: SDS appears to be an independent predictor of short-term ischemic MACE. FAI may further stratify risk among patients with high SDS, with those exhibiting both high SDS and high FAI having the highest event rates. These findings should be considered hypothesis-generating and warrant confirmation in larger prospective cohorts.