Coronary CT Angiography in Acute Coronary Syndrome and Analysis of Factors That Influence This Assessment.

Objective    To evaluate coronary CT angiography (CCTA) combined with Coronary Artery Disease Reporting and Data System (CAD-RADS) grading and with high-risk plaque characteristics for predicting 30 day major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS).Material and methods    A prospective, multicenter cohort study was conducted by enrolling 300 ACS patients admitted to four tertiary hospitals from January 2023 to June 2024. All patients underwent CCTA examination within 24 h of admission. Coronary artery stenosis severity was assessed using CAD-RADS 2.0 criteria, and high-risk plaque characteristics, including low-density plaque, positive remodeling, spotty calcification, and napkin-ring sign, were analyzed. Baseline clinical data were collected, Global Registry of Acute Coronary Events (GRACE) scores were calculated, and the 30 day MACE incidence was evaluated. Logistic regression analysis was used to evaluate risk factors, and receiver operating characteristic (ROC) curves were used to assess diagnostic performance.Results    The incidence of 30 day MACE was 22.7 % (68 / 300 cases). Spearman's rank correlation analysis demonstrated that MACE incidence showed a significant positive correlation with the CAD-RADS grade (ρ=0.658, p<0.05), increasing from 0 % in CAD-RADS grade 0 to 100 % in CAD-RADS grade 5. Patients in the MACE group were older, had higher prevalence of diabetes and higher GRACE scores (all p<0.05). High-risk plaque characteristics, i.e., low-density plaque, positive remodeling, and napkin-ring sign, were detected more frequently in the MACE group (all p<0.05). Multivariate analysis showed that the GRACE score and positive remodeling were independent predictors of 30 day MACE (both p<0.05). The comprehensive prediction model combining GRACE score, CAD-RADS grading, and high-risk plaque characteristics achieved an area under the ROC curve (AUC) of 0.789, significantly superior to the GRACE score model alone (AUC=0.723, p=0.018), representing a 9.1 % improvement in discriminative ability.Conclusion    A non-invasive imaging examination, CCTA, combined with CAD-RADS grading and high-risk plaque assessment can improve the prediction of 30 day MACE risk in ACS patients beyond traditional risk scores, providing important reference for clinical risk stratification and precision treatment decision-making.