Dynamic Clinical and Imaging Correlates of Rapid Progression in the Target Lesion of the Most Stenotic Coronary Branch on Serial Coronary CT Angiography: A Retrospective Lesion-Level Study.

RATIONALE AND OBJECTIVES: To identify dynamic clinical and imaging correlates of rapid progression in the target lesion of the most stenotic coronary branch using serial coronary CT angiography (CCTA). MATERIALS AND METHODS: This retrospective lesion-level study included 276 patients with at least two CCTA examinations between June 2018 and December 2025. The same target lesion was matched between scans. Rapid progression was defined as an annualized total plaque burden increase of at least 1%. Annualized changes were assessed by logistic regression with sensitivity analyses. Receiver operating characteristic (ROC) analysis described apparent within-sample discrimination. RESULTS: Ninety-nine patients showed rapid progression and 177 did not. In the combined model, annualized changes in systolic blood pressure (odds ratio [OR], 1.581; P = 0.034), homocysteine (OR, 1.954; P = 0.001), diameter stenosis (OR, 1.123; P = 0.010), and lesion calcium score (OR, 1.258; P < 0.001) were associated with rapid progression. Diameter stenosis was the most consistent imaging correlate; lesion calcium score was sensitive to baseline lesion-burden adjustment. The combined model showed an apparent area under the receiver operating characteristic curve (AUC) of 0.841. CONCLUSION: Target-lesion progression on CCTA was associated with adverse dynamic clinical and lesion-level imaging changes, indicating correlates of plaque evolution rather than validated causal predictors.