Predictive value of plaque features quantified by coronary CT angiography for periprocedural myocardial infarction in Non-ST-Segment elevation acute coronary syndrome.

Periprocedural myocardial infarction (PMI) is associated with adverse outcomes, but determinants of its occurrence in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) remain unclear. This study aimed to investigate the predictive value of plaque characteristics quantified by coronary CT angiography (CCTA) for PMI in this population. In this secondary analysis of a prospective multicenter NSTE-ACS cohort, participants who underwent CCTA before percutaneous coronary intervention were analyzed. Plaque components were defined by CT thresholds: lipid core (< 30 HU), fibrous (30-350 HU), and calcified (≥ 350 HU). Plaque characteristics were comprehensively quantified on CCTA. PMI was adjudicated according to the Fourth Universal Definition of Myocardial Infarction. A total of 201 participants (mean age 56.8 years ± 11.3 [SD]; 170 male) were included for the analysis. PMI occurred in 30 (14.9%) participants. Lipid core burden (adjusted OR: 1.05; 95% CI: 1.01-1.09; P = 0.03) and plaque length (adjusted OR: 1.04; 95% CI: 1.01-1.07; P = 0.02) were independent predictors of PMI, with optimal cutoffs of 30.6% and 45.0 mm. The addition of dichotomized lipid core burden and plaque length to a baseline model significantly improved predictive performance, as indicated by an integrated discrimination improvement (IDI) of 0.11 (P < 0.001) and a net reclassification improvement (NRI) of 0.60 (P = 0.002). In patients with NSTE-ACS, CCTA-quantified lipid core burden and plaque length were independently associated with the risk of PMI. Pre-procedural CCTA plaque assessment improves risk stratification for PMI and may aid in planning individualized PCI strategies.