Lack of Incremental Prognostic Value of Pericoronary Adipose Tissue Computed Tomography Attenuation Beyond Coronary Artery Disease Reporting and Data System for Major Adverse Cardiovascular Events in Patients With Acute Chest Pain

Abstract

Background: Pericoronary adipose tissue (PCAT) and Coronary Artery Disease Reporting and Data System (CAD-RADS) category had prognostic values for major adverse cardiovascular events (MACEs). However, little is known about the difference between CAD-RADS and PCAT computed tomography (CT) attenuation for predicting MACEs. This study was to compare the prognostic value of PCAT and CAD-RADS for MACEs in patients with acute chest pain. Methods: Between January 2010 and December 2021, all consecutive emergency patients with acute chest pain referred for coronary computed tomography angiography were enrolled in this retrospective study. MACEs included unstable angina requiring hospitalization, coronary revascularization, nonfatal myocardial infarction, and all-cause death. Patients’ clinical characteristics, CAD-RADS, and PCAT CT attenuation were used to evaluate risk factors of MACEs using multivariable Cox regression analysis. Results: A total of 1313 patients were evaluated (mean age, 57.13±12.57 years; 782 men). During a median follow-up of 38 months, 142 of the 1313 patients (10.81%) experienced MACEs. Multivariable Cox regression analysis showed that CAD-RADS categories 2, 3, 4, 5 (hazard ratio range, 2.286–8.325; all P <0.005) and right coronary artery PCAT CT attenuation (hazard ratio, 1.033; P =0.006) were independent predictors of MACEs after adjusting for clinical risk factors. The C statistics revealed that CAD-RADS improved risk stratification compared with PCAT CT alone (C-index, 0.760 versus 0.712; P =0.036). However, the benefit of right coronary artery PCAT CT attenuation combined with CAD-RADS was not significant compared with CAD-RADS alone (0.777 versus 0.760; P =0.129). Conclusions: Right coronary artery PCAT CT attenuation and CAD-RADS were independent predictors of MACEs. However, no incremental prognostic value of right coronary artery PCAT CT attenuation beyond CAD-RADS was detected for MACEs in patients with acute chest pain.

Epicardial Adipose Tissue Thickness and Preserved Ejection Fraction Heart Failure

“…The contribution of EAT to the progression of coronary atherosclerosis is well recognized [43,44]. However, the usefulness of EAT attenuation for risk stratification and prediction of major acute cardiac events remains controversial in patients with CAD [45][46][47].…”

The relationship between different exercise conditions and pericoronary inflammation as quantified by coronary CTA in coronary artery disease

“…In contrast, recent studies have shown that the pericoronary adipose tissue (PCAT) can be used as a marker of coronary artery inflammation [ 12 , 13 ]. and is closely associated with a variety of cardiovascular diseases [ 14 ].…”

Morphological Changes of Peri-Coronary Adipose Tissue Together with Elevated NLR in Acute Myocardial Infarction Patients in-Hospital

“…Moreover, it independently predicts long-term MACEs (Major Adverse Cardiac Events) in patients with acute myocardial infarction. 25 , 26 Nevertheless, previous research has not examined the relationship between adipose tissue volume and FAI around the left anterior descending artery (LAD) and the circumflex artery (LCX) in relation to acute myocardial infarction, nor has it analyzed the adipose tissue surrounding non-culprit lesion vessels during acute myocardial infarction. As a result, it remains unclear whether plaque rupture triggered by vascular inflammation during acute myocardial infarction solely induces inflammation in the corresponding culprit coronary artery adipose tissue, or if it also provokes inflammation in the entire epicardial vascular adipose tissue.…”