Figure 2. Prognostic value of coronary hemodynamic properties in relation to plaque characteristics.

In the EMERALD study that included 216 lesions from 72 patients with ACS, lesion characteristics were compared between 66 culprit and 150 non-culprit lesions on CCTA taken before ACS events. (A) The correlation of the number of adverse plaque characteristics (i.e., low-attenuation plaque, positive remodeling, spotty calcification, and napkin-ring sign) and adverse hemodynamic characteristics (i.e., FFR_CT ≤0.80, ΔFFR_CT ≥0.06, WSS ≥154.7 dyn/cm², and axial plaque stress ≥1,606.6 dyn/cm²) with the proportion of culprit lesions is shown. (B) The mediation analysis investigated the direct and indirect impact of adverse hemodynamic characteristics on ACS culprit lesions mediated by adverse plaque characteristics.

ACS = acute coronary syndrome; CCTA = coronary computed tomography angiography; CT = computed tomography; EMERALD = Exploring the MEchanism of Plaque Rupture in Acute Coronary Syndrome Using Coronary CT Angiography and computationaL Fluid Dynamic; FFR_CT = CCTA-derived fractional flow reserve; WSS = wall shear stress.

^*The number of adverse plaque or hemodynamic characteristics is shown.