Association of Hemodynamic Disease Severity and Distribution With Risk of Future Acute Coronary Syndrome (JIMG October 2026)-Article: Association of Hemodynamic Disease Severity and Distribution With Risk of Future Acute Coronary Syndrome

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This international, multicenter case-control study examined whether coronary blood-flow severity and its distribution predict acute coronary syndrome (ACS). Researchers analyzed coronary CT angiograms obtained 1 month to 3 years before an ACS event in 351 patients, matching 873 vessels to later angiographic findings. They assessed physiological severity using CT-derived fractional flow reserve (FFRCT) and whether disease was diffuse or focal using the CT-derived pullback pressure gradient (PPGCT), alongside stenosis and plaque characteristics.<br /><br />Both lower FFRCT and higher PPGCT were independently associated with a vessel being the ACS culprit. Risk increased across the categories of nonischemic, diffuse, mixed, and focal disease. Focal disease had the highest observed risk of ACS, including myocardial infarction and unstable angina. After adjustment for stenosis severity and high-risk plaque characteristics, focal disease remained associated with ACS (adjusted odds ratio 2.52). This association was also seen in vessels with or without obstructive stenosis and with or without high-risk plaque. Diffuse disease was not independently associated with increased ACS risk after adjustment.<br /><br />The findings suggest that the location and concentration of physiological pressure loss provide prognostic information beyond conventional anatomical and plaque assessments. Identifying focal disease may help refine risk assessment and could inform future research on preventive revascularization.<br /><br />Because the study used a case-control sample of patients who developed ACS, it cannot establish absolute event rates or show that treating focal disease prevents events. The authors also note the modest sample size and that the findings need validation in broader populations.

Meta Tag

Concept FFR CTA

Concept Coronary Hemodynamic Disease

Concept Acute Coronary Syndrome

Concept PPG CT

Concept Focal Coronary Disease

Keywords

acute coronary syndrome

coronary CT angiography

FFRCT

pullback pressure gradient

focal disease

diffuse disease

coronary blood flow

culprit vessel

high-risk plaque

risk stratification

FFR CTA

Coronary Hemodynamic Disease

Acute Coronary Syndrome

PPG CT

Focal Coronary Disease