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Background:  Association among local hemodynamic parameters and their implications in development of acute coronary syndrome (ACS) have not been fully investigated.   Methods:  A total of 216 lesions in ACS patients undergoing coronary CT angiography (CCTA) before 1–24 months from ACS event were analyzed. High-risk plaque on CCTA was defined as a plaque with ≥2 of low-attenuation plaque, positive remodeling, spotty calcification, and napkin-ring sign. With the use of computational fluid dynamics analysis, fractional flow reserve (FFR) derived from CCTA (FFR CT ) and local hemodynamic parameters including wall shear stress (WSS), axial plaque stress (APS), pressure gradient (PG) across the lesion, and delta FFR CT  across the lesion (ΔFFR CT ) were obtained. The association among local hemodynamics and their discrimination ability for culprit lesions from non-culprit lesions were compared.   Results:  A total of 66 culprit lesions for later ACS and 150 non-culprit lesions were identified. WSS, APS, PG, and ΔFFR CT  were strongly correlated with each other (all  p  < 0.001). This association was persistent in all lesion subtypes according to a vessel, lesion location, anatomical severity, high-risk plaque, or FFR CT  ≤ 0.80. In discrimination of culprit lesions causing ACS from non-culprit lesions, WSS, PG, APS, and ΔFFR CT  were independent predictors after adjustment for lesion characteristics, high-risk plaque, and FFR CT  ≤ 0.80; and all local hemodynamic parameters significantly improved the predictive value for culprit lesions of high-risk plaque and FFR CT  ≤ 0.80 (all  p  < 0.05). The risk prediction model for culprit lesions with FFR CT  ≤ 0.80, high-risk plaque, and ΔFFR CT  had a similar or superior discrimination ability to that with FFR CT  ≤ 0.80, high-risk plaque, and WSS, APS, or PG; and the addition of WSS, APS, or PG into ΔFFR CT  did not improve the model performance.   Conclusions:  Local hemodynamic indices were significantly intercorrelated, and all indices similarly provided additive and independent predictive values for ACS risk over high-risk plaque and impaired FFR CT .

Association Among Local Hemodynamic Parameters Derived From CT Angiography and Their Comparable Implications in Development of Acute Coronary Syndrome