Research Of Clinical Application Based On CCTA-derived Technique In The Assessment Of Coronary Atherosclerotic Plaque With Stable Coronary Artery Disease

Objective: To evaluate the potential and diagnostic value of coronary computed tomography angiography CCTA-derived techniques for risk stratification in patients with stable coronary artery disease(SCAD)by quantitatively and qualitatively evaluating the characteristics of coronary atherosclerotic plaques,hemodynamic changes and lesion vessel morphology in patients with SCAD,including pericoronary adipose attenuation index(FAI),CT coronary fractional flow reserve(CTFFR)and intraluminal density attenuation gradient(TAG).To evaluate the diagnostic ability of ccta-derived techniques for plaque vulnerability and explore the factors affecting plaque vulnerability;This paper attempts to refine the classification of noncalcified plaques by CCTA plaque imaging and explore the clinical association between different classification of non-calcified plaques and SCAD,so as to provide reliable basis for clinical decision-making and provide new ideas for accurate diagnosis and improvement of prognosis of SCAD.Methods: 105 patients with SCAD in our hospital from December 2021 to December2022 were retrospectively analyzed.CCTA imaging data of all patients were collected.Semi-automatic computer software was used to quantify plaque characteristics,including plaque type,plaque composition,total plaque volume,measurement and calculation of coronary artery stenosis degree,total coronary artery volume,pericoronary CT-FAI,CT-FFR,CT-TAG and PCCP,and the above parameters were analyzed at patient level.Statistical analysis included t-test,analysis of variance,receiver operating characteristic curve,correlation analysis,regression analysis,etc.P< 0.05 was considered statistically significant.Results: The CT-FAI,stenosis degree and lesion length of high-risk group were significantly higher than those of non-high-risk group.CT-FFR and CT-TAG of highrisk group were lower than those of non-high-risk group,and the differences were statistically significant(all P < 0.05).CT-FAI and the degree of coronary artery stenosis on CT were risk factors for risk stratification(OR = 1.122;OR = 1.052,P<0.05),and the model constructed by CT-FAI+CT coronary artery stenosis degree has incremental value for the independent prediction model(AUC is improved from 0.836,0.804 to 0.872,P< 0.05);The age,CT-FFR,CT-FAI and the PCCP were clinically associated with plaque vulnerability.PCCP was a risk factor of plaque vulnerability,and had a certain predictive value for vulnerable plaque(AUC = 0.722,sensitivity64%,specificity 72%,P< 0.01).There were significant differences in CT-FFR and CT-FAI between PCCP ≥ 0-25% and PCCP ≥ 50%-75%(0.77 ± 0.09 vs.0.81 ±0.08,P< 0.05;-79.06 ± 6.89 vs.-83.83 ± 8.60,P< 0.05);There were significant differences in CT-FFR and CT-FAI between PCCP ≥ 0-25% and PCCP ≥ 75%-100%(0.77 ± 0.09 vs.0.83 ± 0.05,P< 0.05;-79.06± 6.89 vs.-84.30 ± 3.86,P<0.05).The change of CT-FAI was correlated with the PCCP(b =-0.012,t =-2.744,P= 0.007).The change of CT-FFR value was correlated with the PCCP(b = 1.285,t =3.057,P = 0.003).There was a correlation between the lesion length and PCCP(b =0.004,t =2.010,P = 0.048).There was a correlation between the degree of coronary artery stenosis and the PCCP(b = 0.004,t = 2.303,P = 0.024).Conclusion: CTA-derived plaque assessment provides information on plaque composition and hemodynamics,and multi-angle analysis of coronary atherosclerotic plaque morphology,local inflammatory infiltration;It not only has clinical correlation with characteristic parameters of atherosclerotic plaque,but also has important value in risk stratification and prediction of vulnerable plaque in patients with SCAD.It can find high-risk patients in patients with SCAD early,identify potential vulnerable plaque,provide reliable basis for clinical decision-making,improve patient prognosis,and benefit patients from examination.