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.