Despite the widespread use of stents, previous studies have shown that stent implantation mainly relieves symptoms but may not significantly improve long-term outcomes in patients with stable coronary artery disease. Identifying the types of plaques that are most likely to benefit from stenting is essential for improving personalized treatment. This study explores whether coronary computed tomography angiography (CCTA)-derived imaging biomarkers of coronary plaques are associated with increased risk of adverse outcomes after percutaneous coronary intervention (PCI). Around 2,000 patients who underwent CCTA followed by stent placement were included. Advanced software was used to quantify plaque inflammation and composition. Findings from this research may help guide personalized treatment strategies in patients undergoing PCI.

Inclusion Criteria:

1. patients aged 18 years or older;
2. patients who underwent clinically indicated PCI within 30 days following CCTA;
3. CCTA demonstrating the presence of coronary atherosclerotic plaque.

Exclusion Criteria:

1. patients whose PCI within 30 days after CCTA was performed on an emergency basis;
2. elevated cardiac troponin levels within the 3 months preceding PCI;
3. inadequate CCTA image quality;
4. balloon-only or mixed stent/balloon PCI strategies;
5. PCI for non-atherosclerotic lesions (e.g., in-stent restenosis, spontaneous coronary dissection);
6. history of coronary artery bypass grafting;
7. heart failure;
8. non-ischemic cardiomyopathy;
9. significant valvular heart disease;
10. refractory hypertension;
11. persistent atrial fibrillation.

Patients who underwent clinically indicated PCI within 30 days after coronary CT angiography.

Individual participant data will not be shared due to institutional data privacy policies and lack of data-sharing agreements.