Predictive Value of CCTA Plaque Characteristics for the Progression and Prognosis of Coronary Artery Stenosis

Objective: To investigate the value of qualitative and quantitative plaque characteristics on coronary computed tomography angiography (CCTA) in predicting coronary stenosis progression and prognosis. Methods: This retrospective study analyzed the data of66 patients who underwent two CCTA examinations in Jining First People’s Hospital from May 2018 to August 2023. Patients were categorized into non-progressive and progressive groups. CCTA images were processed with an artificial intelligence software for plaque analysis, identifying 87 plaques. Analysis parameters included general clinical data; plaque characteristics; stenosis range; plaque length; CT values and volumes of calcified, non-calcified, and low-density components; total plaque volume; total calcification score; equivalent mass of calcified plaque; remodeling index; low-density plaque; positive remodeling; "napkin-ring sign;" and punctate calcification. Prognoses were compared between the progression and non-progression groups and between the vulnerable and non-vulnerable plaque groups. Results: The progression group had a higher proportion of patients with diabetes and vulnerable plaques compared to the non-progression group (t=6.42, P=0.021). The calcification score, calcified component volume, proportion of calcified components, and equivalent mass of calcified plaque in the progression group were lower than those in the non-progression group (t=−2.38, −2.44, −2.04, −2.08, respectively; P<0.05), whereas punctate calcification incidence was higher than that in the non-progression group (P=0.002). Multivariate logistic regression analysis indicated that diabetes (odds ratio OR=3.67, 95% confidence interval CI: 1.21–11.11, P=0.022), vulnerable plaque (OR=3.97, 95% CI: 1.32–11.94, P=0.014), and punctate calcification (OR=5.73, 95% CI: 2.03–16.17, P<0.001) were independent risk factors for stenosis progression, whereas calcification volume (OR=0.986, 95% CI: 0.976–0.997, P=0.009) was an independent protective factor. Survival analysis curve revealed that major adverse cardiovascular event-free survival rate was significantly lower in the progression group than in the non-progression group and similarly lower in the vulnerable plaque group than in the non-vulnerable plaque group (P=0.014). Conclusions: Diabetes, vulnerable plaques, and punctate calcification are independent risk factors for coronary stenosis progression, whereas calcified component volume is an independent protective factor. The qualitative and quantitative characteristics of plaques on coronary CTA provide a good clinical value for predicting the progression and prognosis of coronary stenosis.