What is the clinical evidence from this study?

Study design: Cohort. Population: Patients undergoing coronary computed tomography angiography (n=3158). Intervention: High-risk plaque (HRP) by CTA vs. Absence of high-risk plaque (HRP(-)). Primary outcome: Fatal and nonfatal acute coronary syndrome (ACS).

What question did this study set out to answer?

This study aims to determine if plaque characteristics identified by coronary computed tomography angiography predict mid-term acute coronary syndrome risk.

April 21, 2026

Plaque Characterization by Coronary Computed Tomography Angiography and the Likelihood of Acute Coronary Events in Mid-Term Follow-Up

Key Result

CTA-verified high-risk plaque predicted acute coronary syndrome, occurring in 16.3% of HRP(+) patients versus 1.4% of HRP(-) patients over a mean follow-up of 3.9 years.

Key Points

This study aims to determine if plaque characteristics identified by coronary computed tomography angiography predict mid-term acute coronary syndrome risk.
Evaluated coronary computed tomography angiography in 3,158 patients to identify high-risk plaque and significant stenosis.
Conducted serial CTA in 449 patients to assess plaque progression.
Recorded outcomes of fatal and nonfatal acute coronary syndrome during a mean follow-up of 3.9 years.
Acute coronary syndrome occurred in 88 patients (2.8%), with higher rates in those with high-risk plaque (16.3% vs 1.4%).
Patients with significant stenosis had a higher incidence of ACS (5.5%) compared to those without (2.1%).
Plaque progression was an independent predictor of ACS, showing 27% incidence in high-risk patients compared to 0.3% in those without high-risk plaque.

Study Design

Type

Cohort (n=3,158)

Structured PICO

Does plaque characterization by coronary CTA predict the mid-term likelihood of acute coronary syndrome in patients undergoing CTA?

Population

3,158 patients undergoing coronary computed tomography angiography (CTA), with a subset of 449 patients undergoing serial CTA.

Intervention

Plaque characterization by CTA (evaluation of high-risk plaque [HRP], significant stenosis [SS] ≥70%, and plaque progression [PP] on serial CTA)

Comparator

Patients without high-risk plaque, without significant stenosis, or without plaque progression

Outcome

Fatal and nonfatal acute coronary syndrome (ACS)hard clinical

CTA-verified high-risk plaque and plaque progression are strong independent predictors of mid-term ACS, although a similar absolute number of ACS events arise from non-high-risk plaques due to their higher overall prevalence.

Main Result

Absolute Event Rate: 16.3% vs 1.4%

Abstract

BACKGROUND Coronary computed tomography angiography (CTA)-verified positive remodeling and low attenuation plaques are considered morphological characteristics of high-risk plaque (HRP) and predict short-term risk of acute coronary syndrome (ACS). OBJECTIVES This study evaluated whether plaque characteristics by CTA predict mid-term likelihood of ACS. METHODS The presence of HRP and significant stenosis (SS) of ≥70% were evaluated in 3,158 patients undergoing CTA. Serial CTA was performed in 449 patients, and plaque progression (PP) was evaluated. Outcomes (fatal and nonfatal ACS) were recorded during follow-up (mean 3.9 ± 2.4 years). RESULTS ACS occurred in 88 (2.8%) patients: 48 (16.3%) of 294 HRP(+) and 40 (1.4%) of 2,864 HRP(-) patients. ACS was also significantly more frequent in SS(+) (36 of 659; 5.5%) than SS(-) patients (52 of 2,499; 2.1%). HRP(+)/SS(+) (19%) and HRP(+)/SS(-) (15%) had higher rates of ACS compared with no-plaque patients (0.6%). Although ACS incidence was relatively low in HRP(-) patients, the cumulative number of patients with ACS developing from HRP(-) lesions (n = 43) was similar to ACS patients with HRP(+) lesions (n = 45). In patients with serial CTA, PP also was an independent predictor of ACS, with HRP (27%; p < 0.0001) and without HRP (10%) compared with HRP(-)/PP(-) patients (0.3%). CONCLUSIONS CTA-verified HRP was an independent predictor of ACS. However, the cumulative number of ACS patients with HRP(-) was similar to patients with HRP(+). Additionally, plaque progression detected by serial CTA was an independent predictor of ACS.