Coronary CT Angiography Quantitative Features and Outcomes After Complete Revascularization in Acute Coronary...

To evaluate the association of coronary CT angiography (CTA)-derived quantitative characteristics and pericoronary adipose tissue (PCAT) attenuation with cardiovascular events following complete revascularization.

This retrospective cohort study (March 2020-March 2023) enrolled consecutive acute coronary syndrome (ACS) patients receiving complete revascularization. Pre-procedural CTA quantified plaque volume, composition, length, and PCAT attenuation. The primary endpoint was the patient-oriented composite endpoint (POCE: cardiac death, myocardial infarction, ischemia-driven revascularization). Vessel-oriented composite endpoint (VOCE) was assessed at the vessel level. Data entry and auditing were performed by formally trained research staff to ensure high data accuracy and minimize missing data. No imputation was used to infer missing values.

Among 1027 patients (mean age, 60.5 years ± 10.0 [standard deviation]; 748 men), 89 (8.7%) experienced POCE over median 2.8-year follow-up. In the adjusted model, greater calcified plaque volume (hazard ratio [HR], 1.21; P = 0.04), longer plaque length (HR, 1.23; P = 0.049), and higher PCAT fat attenuation index (FAI) (HR, 1.37; P<0.01) predicted POCE. Per-vessel analysis yielded consistent findings, with plaque length, calcified volume, and PCAT-FAI significantly associated with VOCE in both target and non-target vessels. Moreover, adding CTA features to clinical models improved prediction of POCE (AUC, 0.71 to 0.76; P<0.01).

Coronary CTA quantitative features were associated with residual cardiovascular events after complete revascularization at both patient and vessel levels and improved prognostic assessment beyond clinical factors.