PURPOSE: The study aimed to assess various characteristics of coronary computed tomography angiography (CCTA) in patients presenting with suspected coronary artery disease (CAD). Additionally, the research sought to investigate the predictive value of the coronary artery volume to myocardial mass (V/M) derived from CCTA in risk stratification for patients with acute coronary syndrome (ACS) and to determine the relationship between the V/M ratio and the Global Registry of Acute Coronary Events (GRACE) risk score in ACS. METHODS: This was a single-center, retrospective study. The magnitude of V/M was investigated in patients with ACS ( RESULTS: The Mantel test analysis shows that the key factors of ACS were left ventricle myocardial mass (M), V/M, and coronary CT angiography-derived fractional flow reserve (FFR CONCLUSIONS: The V/M ratio is valuable for stratified risk prediction of ACS and is independently associated with the GRACE risk score.