Why the study?
Coronary atherosclerosis shows segment-specific heterogeneity, but its relationship with imaging characteristics and metabolic biomarkers remains incompletely understood.
Proximal-mid coronary atherosclerosis is associated with a higher metabolic risk burden and more vulnerable plaque characteristics compared to distal disease, suggesting GGT and NFS as potential markers for segment-specific disease.
Segment-specific patterns may refine CAD risk assessment; leaves open whether metabolic biomarkers predict plaque progression prospectively.
Purpose Coronary atherosclerosis exhibits segment-specific heterogeneity, but its relationship with imaging characteristics and metabolic biomarkers remains incompletely understood. The study aimed to investigate the segmental distribution of coronary atherosclerosis and their associations with plaque morphology and metabolic biomarkers. Methods This retrospective study enrolled 246 coronary artery disease patients underwent coronary angiography. Based on the predominant location of atherosclerotic lesions observed on coronary angiography, patients were classified into the proximal-mid group (n = 140) and the distal group (n = 106). Demographic data, lipid profiles, GGT, NFS, fasting glucose, HbA1c, liver function tests, and angiographic characteristics including Gensini score, plaque morphology (calcified/non-calcified/mixed), high-risk features (ulceration, thrombus, irregular borders), eccentricity, and stenosis severity were analyzed. Results The proximal-mid group had higher prevalence of smoking (57.14% vs. 41.51%) and diabetes (34.29% vs. 20.75%), elevated LDL-C (4.08 ± 0.51 vs. 3.86 ± 0.49 mmol/L), GGT (37.84 ± 2.71 vs. 35.92 ± 2.18 U/L), NFS (−0.99 ± 0.27 vs. −1.08 ± 0.32), and total Gensini score (38.24 ± 8.52 vs. 30.18 ± 7.45) (all P < 0.05). Non-calcified plaques (37.86% vs. 23.58%) and high-risk features (41.43% vs. 28.3%) were more frequent in the proximal-mid group. GGT correlated more strongly with proximal-mid involvement (rho = 0.353) than with total Gensini score (rho = 0.193). Diabetes (OR = 2.285), LDL-C (OR = 2.571), GGT (OR = 1.381), NFS (OR = 1.602), and fasting glucose (OR = 1.017) were independently associated with proximal-mid involvement. Conclusion Proximal-mid coronary atherosclerosis is associated with higher metabolic risk burden and more vulnerable plaque characteristics, with GGT and NFS emerging as potential markers for segment-specific disease.
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Zhu et al. (2026) studied this question.
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