Anatomical vs Physiological Lesion Characteristics in Prediction of Acute Coronary Syndrome
Authors' conclusion
Luminal narrowing, plaque quality and quantity, and local hemodynamics were independent predictors of ACS, offering specificity in physiology and sensitivity in anatomy. A comprehensive assessment of them further refined the risk prediction for future ACS.
Study context
- Population
- Acute coronary syndrome (ACS) patients who underwent coronary CT angiography 1 month to 3 years before the event
- Participants
- 351 patients · 2,451 lesions
- Comparison
- ΔFFRCT vs Combined anatomy
- Outcome
- Diagnostic performance in identifying ACS culprit lesions
Methodological detailsinternational, multicentre, internal case-control, core lab coronary computed tomography angiography (CCTA) analyses, Median interval to ACS 375 [95.0-644.5] days
- International
- Multicentre
- Internal case-control
- Core lab CCTA analyses
- Median interval to ACS 375 [95.0-644.5] days
Main finding
As reported in the abstract
Identification of ACS culprit lesions
| Group | AUC | Sensitivity (highest) | Specificity (highest) |
|---|---|---|---|
| Plaque burden ≥70% | Not reported in the abstract | 90.6% (87.2%-93.2%) | Not reported in the abstract |
| ΔFFRCT ≥0.10 | Not reported in the abstract | Not reported in the abstract | 88.3% (86.9%-89.6%) |
| ΔFFRCT | 0.805 [0.782-0.829] | Not reported in the abstract | Not reported in the abstract |
| Combined anatomy | 0.802 [0.777-0.826] | Not reported in the abstract | Not reported in the abstract |
AUC
Plaque burden ≥70%Not reported in the abstract
ΔFFRCT ≥0.10Not reported in the abstract
ΔFFRCT0.805 [0.782-0.829]
Combined anatomy0.802 [0.777-0.826]
Sensitivity (highest)
Plaque burden ≥70%90.6% (87.2%-93.2%)
ΔFFRCT ≥0.10Not reported in the abstract
ΔFFRCTNot reported in the abstract
Combined anatomyNot reported in the abstract
Specificity (highest)
Plaque burden ≥70%Not reported in the abstract
ΔFFRCT ≥0.1088.3% (86.9%-89.6%)
ΔFFRCTNot reported in the abstract
Combined anatomyNot reported in the abstract
- ΔFFRCT vs Combined anatomy: P = 0.748 — similar predictability, with additive discrimination towards each other
- Lesions that became ACS culprits
- 363 (14.8%)
- All anatomical and simulated physiological characteristics independently associated with culprit lesions
- all P < 0.001
Observational data: associations, not effects.
Original publication
Anatomical vs Physiological Lesion Characteristics in Prediction of Acute Coronary Syndrome. JACC Cardiovasc Interv. Published 8 December 2025. doi:10.
Summarised from the published abstract; every number is checked against it