The Value Of Coronary Plaque Characteristics And Periplaque FAI In Predicting Acute Coronary Syndrome

Objective:To investigate the ability of plaque characteristics and peri-plaque fat attenuation index(FAI)based on coronary computed tomography angiography(CCTA)in predicting acute coronary syndrome.Methods:The clinical and imaging data of patients who underwent CCTA examination in the Second People’s Hospital of Changzhou Affiliated to Nanjing Medical University from January,2019 to December,2021 were retrospectively collected.According to the results of clinical diagnosis,the population was divided into acute coronary syndrome group and non-acute coronary syndrome group.At the same time,the culprit coronary artery in patients with acute coronary syndrome was determined by the results of invasive coronary angiography(ICA)and electrocardiogram.Finally,30 patients with acute coronary syndrome(ACS)and 25 patients with non-acute coronary syndrome were enrolled,and a total of 112 diseased coronary arteries were included in the study.Among them,there were 36 culprit coronary arteries and 35 non-culprit coronary arteries in patients with acute coronary syndrome.The peri-plaque FAI,plaque stenosis area,plaque length and adverse plaque characteristics of each coronary artery were measured by Shukun post-processing software.The peri-plaque FAI,plaque stenosis area and plaque length were manually corrected on the basis of automatic identification.The measurement range of peri-plaque FAI was the diameter and width of the peripheral vessel wall,which was consistent with the plaque length.According to the parameters obtained by Shukun post-processing software,Logistic regression analysiswas used to analyze the role of each parameter in predicting acute coronary syndrome.The receiver characteristic curve(ROC)was used to calculate the value of different models in predicting acute coronary syndrome.Results:This study included 30 patients with acute coronary syndrome(ACS)and 25 patients with non-ACS.A total of 112 diseased coronary arteries were included in the study.Among them,there were 36 culprit coronary arteries and 35 non-culprit coronary arteries in patients with acute coronary syndrome.There were no significant differences in age,body mass index(BMI),gender,and the proportion of hypertension,diabetes,hyperlipidemia,smoking,and drinking between the two groups of patients with acute coronary syndrome and non-acute coronary syndrome(P > 0.05).There were significant differences in coronary stenosis rate,plaque length,adverse plaque characteristics such as spotty calcification,low density plaque,positive remodeling,and napkin ring sign between patients with acute coronary syndrome and non-acute coronary syndrome(P <0.05),but there was no significant difference in FAI around plaque(P > 0.05).Only the stenosis rate and adverse plaque features such as punctate calcification,low density plaque,positive remodeling and napkin ring sign were statistically significant between culprit and non-culprit coronary arteries(P < 0.05).Logistic regression analysis showed that spotty calcification,positive remodeling and napkin ring sign were independent predictors of acute coronary syndrome.Only positive remodeling and napkin ring sign were independent predictors of culprit vessels in patients with acute coronary heart disease.According to the results of Logistic regression analysis,a combined model was established to predict patients with acute coronary heart disease,and the AUC of the diagnostic efficacy of the model was 0.921(P <0.05).Conclusion:Positive remodeling and napkin ring sign are independent predictors of adverse plaque characteristics in culprit coronary arteries in patients with acute coronary syndrome.The combined diagnostic model based on CCTA has important value in predicting stenosis rate,plaque length,spotty calcification,napkin ring sign and positive remodeling in acute coronary syndrome.