Work

Non-invasive identification of high-risk plaques in non-culprit lesions of acute coronary syndrome

Year: 2026

Type: article

Abstract: Identifying high-risk plaques (HRPs) using non-invasive imaging modalities is clinically important. The diagnostic value of combining coronary computed tomography angiography (CCTA)–derived measurements with fractional flow reserve derived from computed tomography (FFR CT ) for detecting HRPs in non-culprit lesions of acute coronary syndrome (ACS) remains to be clarified. This study aimed to assess whether ΔFFR CT and CCTA-derived plaque features can accurately identify HRPs detected by near-infrared spectroscopy and intravascular ultrasound (NIRS-IVUS) in non-culprit lesions of ACS. We prospectively evaluated 105 non-culprit coronary lesions using CCTA, FFR CT , and NIRS-IVUS in 32 patients with ACS. ΔFFR CT was calculated as the difference in FFR CT across the stenosis. Receiver operating characteristic (ROC) analysis determined the optimal cutoff values of ΔFFR CT and CCTA-derived plaque features for predicting a maximum 4-mm lipid core burden index (maxLCBI 4mm ) ≥ 400. Both ΔFFR CT values and CCTA-derived plaque features were associated with a maxLCBI 4mm ≥ 400 (both P < 0.05). The optimal cutoff values of ΔFFR CT and plaque density for predicting a maxLCBI 4mm ≥ 400 were 0.06 and 29 Hounsfield units, respectively. The combination of ΔFFR CT ≥ 0.06 and low plaque density predicted a maxLCBI 4mm ≥ 400 with 89.1% sensitivity and 84.8% specificity (area under the curve = 0.90; P < 0.0001). In multivariate analysis, plaque density ≤ 29 HU and ΔFFR CT ≥ 0.06 independently predicted a maxLCBI 4mm ≥ 400. The combination of ΔFFR CT ≧0.06 and plaque density on CCTA predicted a maxLCBI 4mm ≧400 with 89.1% sensitivity and 84.8% specificity (area under the curve, 0.90; P < 0.0001). In multivariate analysis, plaque density ≦ 29 (odds ratio 7.72, 95% confidence interval 2.10–28.44, P = 0.002) and ΔFFR CT ≧0.06 (4.55, 1.21–17.04, P = 0.02) were independent predictors of a maxLCBI 4mm ≧400. HRPs with a maxLCBI 4mm ≧400 can be diagnosed with high accuracy by confirming a plaque density ≦ 29 in lesions with ΔFFR CT ≧0.06.

Source: Heart and Vessels

DOI: 10.1007/s00380-026-02663-6