Publication of the Week - 09/19/2025

Title

CTA-Derived Plaque Characteristics and Risk of Acute Coronary Syndrome in Patients With Coronary Artery Calcium Score of Zero: Insights From the ICONIC Trial

Authors

Rebecca A. Jonas, MD, Nick S. Nurmohamed MD, PhD, Tami R. Crabtree, MS, Melissa Aquino, MS, Robert S. Jennings, RT , Andrew D. Choi, MD, Fay Y. Lin, MD, Sang-Eun Lee, MD, PhD, Daniele Andreini, MD, PhD, Jeroen Bax, MD, PhD , Fillipo Cademartiri, MD, PhD, Kavitha Chinnaiyan, MD, Benjamin J. W. Chow, MD, Edoardo Conte, MD, Ricardo Cury, MD , Gudrun Feuchtner, MD, Martin Hadamitzky, MD, Yong-Jin Kim, MD, PhD, Erica Maffei, MD, Hugo Marques, MD, PhD , Fabian Plank, MD, PhD, Gianluca Pontone, MD, PhD, Alexander R. van Rosendael, MD, PhD, Todd C. Villines, MD , Subhi J. Al’Aref, MD, Lohendran Baskaran, MD, Iksung Cho, MD, Ibrahim Danad, MD, PhD, Ran Heo, MD , Ji Hyun Lee, MD, Asim Rizvi, MD, Wijnand J. Stuijfzand, MD, PhD, Ji Min Sung, MD, Hyung-Bok Park, MD, PhD , Matthew J. Budoff, MD, Habib Samady, MD, Leslee J. Shaw, PhD, Peter H. Stone, MD, Renu Virmani, MD , Jagat Narula, MD, PhD, James K. Min, MD, James P. Earls, MD, Hyuk-Jae Chang, MD

Journal

AJR American Journal of Roentgenology

Background

Coronary artery calcium (CAC) scoring is used to stratify acute coronary syndrome (ACS) risk. Nonetheless, patients with a CAC score of zero remain at risk from noncalcified plaque components.

Objective

The purpose of this study was to explore CTA-derived coronary artery plaque characteristics in symptomatic patients with CACo who subsequently have ACS through comparisons with patients with a CAC score greater than o who subsequently have ACS as well as with patients with CACo who do not subsequently have ACS.