Prognostic Value Of Plaque Characteristics And Hemodynamic Changes Derived By Coronary CTA For Acute Coronary Syndrome

Objective To evaluate the predictive value of anatomic severity,plaque characteristics associated with fractional flow reserve derived by coronary computed tomographic angiography(CT-FFR)for subsequent acute coronary syndrome(ACS).Methods We followed up 458 patients with suspected coronary artery disease who underwent CCTA at Ningxia Medical University General Hospital from June 2017 to December 2020 for a mean of 3.9 years,with 56 patients presenting with ACS events,the propensity score matching method(n=1:4)was used to screen 204 sex-and age-matched patients without ACS as the control group.The final study population consisted of a total of 56 ACS patients(containing 56 culprit lesions)and 204 controls(containing 229 nonculprit lesions).Based on the lesion level,the differences in anatomical features,plaque characteristics and CT-FFR of coronary lesions between culprit lesions and nonculprit lesions were compared and analyzed,and the risk ratio(HR)and 95%confidence interval(CI)of different lesion characteristics were calculated by COX proportional risk regression analysis.The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),the area under the curve(AUC)and 95%confidence interval(CI)of the single and composite index model was calculated by using the receiver operating characteristic(ROC)curve.ResultsThe different plaque features between culprit lesions and nonculprit lesions were compared at the level of the per lesion.The results were as follows:(1)There were significant differences between culprit and nonculprit lesions in the comparison of anatomical and hemodynamical indicators.Compared with nonculprit lesions,culprit lesions had higher Luminal diameter stenosis rate,non-calcified plaque volume burden,ΔCT-FFR,low-attenuation plaque and spotty calcification as well as lower CT-FFR,calcified plaque volume and minimum lumen area(all P<0.05).(2)ΔCT-FFR(HR:3.03,95%CI:1.39-6.60,P=0.0054)is the most important risk factor for future ACS,followed by non-calcified plaque burden(HR:2.80,95%CI:1.24-6.33,P=0.0133),minimum lumen area(HR:2.56,95%CI:1.24-5.28,P=0.0113)and low-attenuation plaque(HR:2.15,95%CI:1.20-3.88,P=0.0105).(3)Prediction model(including low-attenuation plaque,non-calcified plaque burden,minimum lumen area andΔCT-FFR)has the highest prediction ability for ACS events(AUC:0.865,95%CI:0.820-0.903).The sensitivity,specificity,positive predictive value and negative predictive value of the model combined with the above indicators were 78.57%,81.66%,51.20%and 94.00%respectively.Conclusion?CT-FFR≥0.06、MLA≤2.94mm~2、NPB≥39.5%and low-attenuation plaque suggested a higher risk of ACS.Combined with anatomical severity,qualitative and quantitative assessment of plaque and hemodynamic changes,the comprehensive assessment of coronary artery disease can improve the identification of vulnerable plaque with high risk of ACS in the future,thus improving the predictive value of ACS.