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

Summary

A dual-timeframe CCTA model integrating stenosis, low-density plaque burden, and ΔCT-FFR provided simultaneous prediction of short-term (≤7 days) and long-term (≥30 days) ACS risk. ΔCT-FFR uniquely captured short-term hazard, and combined models outperformed stenosis-based assessment across external cohorts.

Key Findings

• Stenosis severity and low-density plaque burden predicted ACS risk in both ≤7-day and ≥30-day windows.
• ΔCT-FFR (proximal minus distal CT-FFR) was specifically associated with short-term (≤7 days) ACS risk.
• Combined models (stenosis + LDP% + ΔCT-FFR + population data) outperformed stenosis alone and demonstrated greater net clinical benefit across multiple external cohorts.

Clinical Implications

Incorporating ΔCT-FFR and LDP% into CCTA interpretation may improve triage beyond stenosis severity alone, identifying patients at near-term risk for ACS while informing longer-term management.

Limitations

• Abstract does not report exact sample size and event counts
• ΔCT-FFR and LDP% require high-quality imaging and standardization; prospective impact studies needed

Future Directions

Prospective trials to test management strategies guided by ΔCT-FFR and LDP% and to quantify effects on near-term events and resource utilization.