E-Thesis 103 views 19 downloads
High-Risk Coronary Plaques and Cardiovascular Prevention: Insights from Coronary Computed Tomography Angiography and Real-World Data / AHMED SALEM
Swansea University Author: AHMED SALEM
DOI (Published version): 10.23889/SUThesis.72008
Abstract
Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of morbidity and mortalityworldwide, necessitating improved methods for early detection and risk stratification. Coronary CTangiography (CCTA) has emerged as a powerful, non-invasive imaging modality capable of identifyinghigh-ri...
| Published: |
Swansea
2026
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| Institution: | Swansea University |
| Degree level: | Doctoral |
| Degree name: | Professional Doctorate |
| Supervisor: | Halcox, J., and Stephens, J. |
| URI: | https://cronfa.swan.ac.uk/Record/cronfa72008 |
| Abstract: |
Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of morbidity and mortalityworldwide, necessitating improved methods for early detection and risk stratification. Coronary CTangiography (CCTA) has emerged as a powerful, non-invasive imaging modality capable of identifyinghigh-risk coronary plaque features that may predict future cardiovascular events. This thesis explores the role of CCTA in assessing plaque vulnerability, guiding risk factor optimisation, and influencing clinical outcomes in patients with stable and acute coronary syndrome (ACS).The methodology section outlines the study designs, data collection strategies, and analytical approaches used across multiple clinical studies, integrating both CCTA-based imaging assessments and real-world national cohort analyses. The thesis then presents several key investigations, beginning with a real-world analysis of secondary prevention in high-risk patients with type 2 diabetes, evaluating the achievement of European Society of Cardiology (ESC) guideline-recommended risk factor targets. This is followed by a detailed characterisation of high-risk coronary plaques, including the novel CT-defined thin-cap fibroatheroma (CT-TCFA), in patients undergoing CCTA for stable chest pain. Further, the research assesses how high-risk plaque features identified on CCTA influence cardiovascular risk optimisation, medication intensification, and clinical decision-making. The spatial distribution of vulnerable plaques within the coronary tree is also analysed to provide insights into the patterns of plaque progression and rupture potential. Lastly, as a future work, I’m planning to explore the potential impact of oral semaglutide on coronary artery disease progression following ACS, evaluating its role in modulating atherosclerotic plaque burden and stabilizing high-risk lesions. Collectively, this body of work highlights the critical role of CCTA in refining cardiovascular risk assessment, facilitating early intervention, and guiding therapeutic strategies to improve patient outcomes. The findings underscore the need for a more personalised approach to cardiovascular prevention, leveraging advanced imaging and targeted pharmacotherapy to mitigate the burden of ASCVD. |
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| Keywords: |
CCTA, vulnerable plaque, CT-TCFA, cardiovascular prevention, type 2 diabetes, semaglutide |
| College: |
Faculty of Medicine, Health and Life Sciences |
| Funders: |
Swansea Bay University Hospital |