Cardiac computed tomography-derived coronary artery volume to myocardial mass for the prediction of risk stratification for acute coronary syndrome.

Purpose: The study aimed to assess various characteristics of coronary computed tomography angiography (CCTA) in patients presenting with suspected coronary artery disease (CAD). Additionally, the research sought to investigate the predictive value of the coronary artery volume to myocardial mass (V/M) derived from CCTA in risk stratification for patients with acute coronary syndrome (ACS) and to determine the relationship between the V/M ratio and the Global Registry of Acute Coronary Events (GRACE) risk score in ACS.

Methods: This was a single-center, retrospective study. The magnitude of V/M was investigated in patients with ACS ( = 168), stable angina pectoris (SAP) ( = 160), and healthy controls ( = 122) among 450 patients with suspected CAD who did not require urgent angiography. Patients underwent CCTA for 0.5-6 months (median 3.3 months) before the SAP and ACS event. All patients underwent invasive coronary angiography (ICA) at the time of the SAP and ACS event. The Mantel test was used to assess the factors influencing risk stratification in CAD. Receiver Operating Characteristic (ROC) curve analysis was used to assess the accuracy of the V/M ratio in predicting ACS. Pearson correlation analysis was utilized to analyze the correlation between V/M and GRACE risk score, and independent predictors of high GRACE risk score were screened using univariate and multivariate logistic regression analysis.

Results: The Mantel test analysis shows that the key factors of ACS were left ventricle myocardial mass (M), V/M, and coronary CT angiography-derived fractional flow reserve (FFR) ( < 0.01). The V/M ratio in ACS and SAP was significantly lower than in controls (21.7 ± 6.96, 31.0 ± 9.90, vs. 43.3 ± 11.50 mm/g;  < 0.001). Lower V/M ratios were found with the progression of CAD from SAP to unstable angina pectoris (UAP) to acute myocardial infarction (AMI) (17.8 ± 5.30, 24.3 ± 6.70, vs. 31.0 ± 9.90 mm/g;  < 0.001). ROC analysis shows that V/M outperformed FFR, % DS in predicting ACS [AUC: 0.78 [95% CI: 0.74-0.83] vs. 0.74 [95% CI: 0.69-0.79], 0.60 [95% CI: 0.53-0.64]], and the combined AUC of the three increased significantly, reaching 0.80 [95%(CI): 0.76-0.85]. Furthermore, in the subgroup of ACS patients, the results of Pearson correlation analysis shows that the GRACE risk score of ACS patients was significantly negatively correlated with the V/M ratio and V/M was found to be an independent predictor of GRACE risk score >140 ( < 0.001).

Conclusions: The V/M ratio is valuable for stratified risk prediction of ACS and is independently associated with the GRACE risk score.