AbstractBackgroundIsolate features of the coronary anatomy have been associated with the pathophysiology of atherosclerotic disease. Computational methods have been described to allow precise quantification of the complex three‐dimensional (3D) coronary geometry. The present study tested whether quantitative parameters that describe the spatial 3D coronary geometry is associated with the extension and composition of the underlying coronary artery disease (CAD).MethodsPatients with CAD scheduled for percutaneous intervention were investigated with coronary computed tomography angiography (CCTA), and invasive coronary angiography, and virtual histology intravascular ultrasound (IVUS‐VH). For all target vessels, 3D centerlines were extracted from CCTA images and processed to quantify 23 geometric indexes, grouped into 3 main categories as follows: (i) length‐based; (ii) curvature‐based, torsion‐based, and curvature/torsion‐combined; (iii) vessel path‐based. The geometric variables were compared with IVUS‐VH parameters assessing the extent and composition of coronary atherosclerosis.ResultsA total of 36 coronary patients (99 vessels) comprised the study population. From the 23 geometric indexes, 18 parameters were significantly (p < 0.05) associated with at least 1 IVUS‐VH parameter at a univariate analysis. All three main geometric categories provided parameters significantly related with atherosclerosis variables. The 3D geometric indexes were associated with the degree of atherosclerotic extension, as well as with plaque composition. Geometric features remained significantly associated with all IVUS‐VH parameters even after multivariate adjustment for clinical characteristics.ConclusionsQuantitative 3D vessel morphology emerges as a relevant factor associated with atherosclerosis in patients with established CAD.