Incremental prognostic value of pericoronary adipose tissue attenuation beyond conventional features in patients with nonobstructive coronary artery disease

Nan Zheng; Zinuan Liu; Yipu Ding; Xi Wang; Jing Li; Guanhua Dou; Ran Xin; Ziqiang Guo; Guanxi Chen; Jing Jing; Bai He; Dongkai Shan; Junjie Yang

doi:10.1016/j.atherosclerosis.2024.119075

Incremental prognostic value of pericoronary adipose tissue attenuation beyond conventional features in patients with nonobstructive coronary artery disease

Atherosclerosis. 2024 Nov 29:119075. doi: 10.1016/j.atherosclerosis.2024.119075. Online ahead of print.

Authors

Nan Zheng¹, Zinuan Liu¹, Yipu Ding², Xi Wang¹, Jing Li³, Guanhua Dou⁴, Ran Xin², Ziqiang Guo⁵, Guanxi Chen⁵, Jing Jing¹, Bai He¹, Dongkai Shan⁶, Junjie Yang⁷

Affiliations

¹ Senior Department of Cardiology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China.
² Senior Department of Cardiology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China; School of Medicine, Nankai University, Tianjin, China.
³ Beijing West Medical District of Chinese PLA General Hospital, Beijing, China.
⁴ Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
⁵ Senior Department of Cardiology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China; Medical School of Chinese PLA, Beijing, China.
⁶ Senior Department of Cardiology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China. Electronic address: shandongkai1234@163.com.
⁷ Senior Department of Cardiology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China. Electronic address: fearlessyang@126.com.

PMID: 39648054
DOI: 10.1016/j.atherosclerosis.2024.119075

Abstract

Background and aims: It remains uncertain whether pericoronary adipose tissue attenuation (PCATa) is associated with clinical outcome in patients with nonobstructive coronary artery disease (CAD). We aim to investigate the incremental prognostic value of PCATa beyond clinical and coronary computed tomographic angiography (CCTA) features in patients with nonobstructive CAD.

Methods: Consecutive patients with chest pain suspected of CAD referred for CCTA from January 2017 to December 2018 were prospectively included. Multivariable Cox proportional hazard regression analysis was employed to identify the predictive factors for major adverse cardiovascular events (MACE), while the receiver operating characteristics (ROC) curve was utilized to assess the discriminatory capacity of PCATa. Kaplan-Meier curves were ultilized to visually represent event-free survival and were compared using Log-rank tests among groups stratified by high-risk plaque (HRP) and PCATa.

Results: Of the 1614 patients (mean age 59.0 years, 55.6 % male) with nonobstructive CAD, 68 (4.2 %) suffered MACE during a median follow-up of 28.6 months. After multivariable adjustment, PCATa was identified as an independent predictor (HR: 1.060, 95%CI: 1.025-1.096, p = 0.001). The inclusion of PCATa significantly enhanced the discrimination capacity [AUC:0.72 (0.66-0.78), p = 0.041] and risk reclassification (NRI = 1.99, p < 0.001; IDI = 0.93, p < 0.001) beyond the influence of clinical and CCTA factors. In the presence of HRP, a higher PCATa was found to be associated with a relatively higher risk of MACE compared to a lower PCATa (HR: 2.45, 95%CI: 1.09-5.52, p = 0.031).

Conclusions: PCATa is positively correlated with adverse outcome in patients with nonobstructive CAD, and it offers incremental predictive value beyond clinical variables and CCTA characteristics.

Keywords: Atherosclerosis; Coronary CT angiography; Nonobstructive coronary artery disease; Pericoronary adipose tissue; Risk stratification.