{
  "abstract": "Background: Acute coronary syndrome (ACS) arises from disruption of coronary atherosclerotic plaques. We assessed whether integrating coronary CT angiography (CCTA)-defined vulnerable plaque (VP), the systemic immune-inflammation index (SII), and traditional Chinese medicine (TCM) syndrome elements improves prediction of incident ACS.\n\nMethods: This retrospective cohort study enrolled 266 hospitalized patients with >25% coronary stenosis on CCTA (July 2019-July 2021); patients with ACS at baseline were excluded, and all completed a fixed 3-year follow-up from the index CCTA (index date). VP was defined as ≥2 high-risk CCTA features and SII as platelet × neutrophil/lymphocyte count; eight TCM syndrome elements were diagnosed by standardized criteria. Firth-penalized logistic regression with LASSO selection was evaluated by the area under the curve (AUC), calibration, reclassification indices, and decision curve analysis, with selection-inclusive bootstrap internal validation.\n\nResults: Twenty-two patients developed ACS. In the five-variable Firth model, VP (odds ratio [OR] 12.84, 95% confidence interval [CI] 3.64–45.28), SII (OR 1.18 per 100 × 10 ⁹ /L, 95% CI 1.04–1.33; nonlinear association, P for nonlinearity < 0.001), and the phlegm-turbidity syndrome element (OR 3.07, 95% CI 1.15–8.22) independently predicted ACS. The final three-variable model (ORs 16.30, 1.15 per 100 × 10 ⁹ /L, and 3.65, respectively) showed the best apparent discrimination (AUC 0.873, 95% CI 0.806–0.940; selection-inclusive optimism-corrected AUC 0.812, 95% CI 0.741–0.871) and calibration (intercept −0.07, slope 1.06; Brier score 0.0630), with sensitivity 81.8% and specificity 77.9%, the widest net-benefit threshold range (1%–49%), and nominally higher integrated discrimination improvement over the binary VP indicator (0.073, 95% CI 0.021–0.122). Among 94 patients with VP, spotty calcification, the napkin-ring sign, and stenosis severity were also associated with ACS; SII showed a dose-response relationship (Cochran-Armitage Z = 3.075, P = 0.002); and coexisting blood stasis plus phlegm turbidity marked a subgroup with 56.2% ACS incidence (9/16; exploratory) versus 17.5% (7/40) and 13.6% (3/22) for either element alone.\n\nConclusions: An exploratory multimodal model combining CCTA-defined vulnerable plaque, SII, and the phlegm-turbidity syndrome element nominally improved ACS risk prediction over a binary VP indicator. Given the few events and single-center retrospective design, these hypothesis-generating findings require external and prospective validation.",
  "abstract_shown": true,
  "affiliations": [
    "Fourth Clinical Medical College Affiliated to Guangzhou University of Traditional Chinese Medicine",
    "Shenzhen Traditional Chinese Medical Hospital"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Xiling Hu"
    },
    {
      "affs": [
        0
      ],
      "name": "Hong Luo"
    },
    {
      "affs": [
        0
      ],
      "name": "Qingqing Li"
    },
    {
      "affs": [
        1
      ],
      "name": "Mengdan Feng"
    },
    {
      "affs": [
        1
      ],
      "name": "Xinbei Li"
    },
    {
      "affs": [
        1
      ],
      "name": "Mingtai Chen"
    },
    {
      "affs": [
        1
      ],
      "name": "Hanqing Lyu"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/dw6r8ybpx9je5.bib",
  "cited_by": 0,
  "doi": "10.3389/fcvm.2026.2011803",
  "fulltext_url": null,
  "id": "dw6r8ybpx9je5",
  "issns": [
    "2297-055X"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fcvm.2026.2011803/full",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-10",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/dw6r8ybpx9je5.ris",
  "sources": [
    {
      "first_seen": "2026-11-10T12:23:49Z",
      "native_id": "10.3389/fcvm.2026.2011803",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fcvm.2026.2011803/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:2297-055X",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Integrating coronary CT angiography-derived vulnerable plaque features, the systemic immune-inflammation index, and traditional Chinese medicine syndrome elements for prediction of acute coronary syndrome: an exploratory retrospective cohort study",
  "title_text": "Integrating coronary CT angiography-derived vulnerable plaque features, the systemic immune-inflammation index, and traditional Chinese medicine syndrome elements for prediction of acute coronary syndrome: an exploratory retrospective cohort study",
  "type": "peer-reviewed",
  "updated_at": "2026-11-10T12:23:49Z",
  "url": "https://research.draconitic.com/paper/dw6r8ybpx9je5",
  "venue": "Frontiers in Cardiovascular Medicine",
  "versions": []
}