Background and Objectives: Cardiac computed tomography angiography (CCTA) is an excellent non-invasive imaging tool to evaluate coronary arteries and exclude coronary artery disease (CAD). Managing intermediate coronary artery stenosis with negative or inconclusive functional tests is still a challenge. A regular stenosis evaluation together with high-risk plaque features, using semi-automated programs, are becoming promising tools. This case–control study was designed to evaluate the intermediate lesion features’ impact on CAD outcomes, using a semi-automated CCTA atherosclerotic plaque analysis program. Materials and Methods: We performed a single-center, prospective cohort study. A total of 133 patients with low to intermediate risk of CAD, older than 18 years with no previous history of CAD and good quality CCTA images were included in the study, and 194 intermediate stenosis (CAD-RADS 3) were analyzed. For more detailed morphological analysis, we used semi-automated CCTA-dedicated software. Enrolled patients were prospectively followed-up for 2 years. Results: Agatston score was significantly higher in the major adverse cardiovascular events (MACE) group (p = 0.025). Obstruction site analysis showed a significantly lower coronary artery remodeling index (RI) among patients with MACE (p = 0.037); nonetheless RI was negative in both groups. Plaque consistency analysis showed significantly bigger necrotic core area in the MACE group (p = 0.049). In addition, unadjusted multivariate analysis confirmed Agatston score and RI as significant MACE predictors. Conclusions: The Agatston score showes the total area of calcium deposits and higher values are linked to MACE. Higher plaque content of necrotic component is also associated with MACE. Additionally, negatively remodeled plaques are linked to MACE and could be a sign of advanced CAD. The Agatston score and RI are significant in risk stratification for the development of MACE.

Background and Objectives: Serum cortisol has been extensively studied for its role during acute myocardial infarction (AMI). Reports have been inconsistent, with high and low serum cortisol associated with various clinical outcomes. Several publications claim to have developed methods to evaluate cortisol activity by using elements of complete blood count with its differential. This study aims to compare the prognostic value of the cortisol index of Endobiogeny with serum cortisol in AMI patients, and to identify if the risk of mortality in AMI patients can be more precisely assessed by using both troponin I and cortisol index than troponin I alone. Materials and methods: This prospective study included 123 consecutive patients diagnosed with AMI. Diagnostic coronary angiography and revascularization was performed for all patients. Cortisol index was measured on admission, on discharge, and after 6 months. Two year follow-up for all patients was obtained. Results: Our study shows cortisol index peaks at 7–12 h after the onset of AMI, while serum cortisol peaked within 3 h from the onset of AMI. The cortisol index is elevated at admission, then significantly decreases at discharge; furthermore, the decline to its bottom most at 6 months is observed with mean values being constantly elevated. The cortisol index on admission correlated with 24-month mortality. We established combined cut-off values of cortisol index on admission > 100 and troponin I > 1.56 μg/las a prognosticator of poor outcomes for the 24-month period. Conclusions: The cortisol index derived from the global living systems theory of Endobiogeny is more predictive of mortality than serum cortisol. Moreover, a combined assessment of cortisol index and Troponin I during AMI offers more accurate risk stratification of mortality risk than troponin alone.

Background/Objectives: Intermediate coronary artery stenosis is difficult to risk-stratify, as stenosis severity alone often fails to predict events. This study aimed to evaluate whether quantitative CCTA-derived plaque characteristics and lesion morphology are associated with MACE during long-term follow-up. Methods: In this single-center prospective study, 128 patients with stable angina symptoms underwent standardized CCTA and were diagnosed with at least one intermediate coronary stenosis (50–69%, CAD-RADS 3). Quantitative parameters of lesion morphology, lumen geometry, vessel wall dimensions, and plaque composition were assessed using semi-automated CCTA adapted plaque analysis (QAngio CT). Patients were followed for a median of 72 months. MACE was defined as a composite outcome of all-cause mortality, target lesion revascularization, non-fatal MI, and stroke. Results: During follow-up, 26.6% of patients experienced MACE. High-risk plaque features were more frequent in patients with MACE. Lesions associated with MACE demonstrated significantly smaller lumen area, reduced mean lumen diameter, and decreased vessel wall area at the obstruction site. In addition, plaques leading to adverse events exhibited larger necrotic core areas. Although no single quantitative parameter independently predicted MACE, a combined multivariable model incorporating lumen geometry and plaque composition showed significant prognostic value. Conclusions: In patients with intermediate coronary stenosis, lesion-specific quantitative CCTA parameters—particularly luminal geometry and necrotic core extent—provide prognostic information beyond traditional plaque burden and stenosis assessment. Incorporating detailed plaque morphology into routine CCTA evaluation may improve long-term risk stratification and support more individualized clinical management.