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Perivascular fat attenuation for predicting adverse cardiac events in stable patients undergoing invasive coronary angiography

      Abstract

      Background

      Inflammation surrounding the coronary arteries can be non-invasively assessed using pericoronary adipose tissue attenuation (PCAT). While PCAT holds promise for further risk stratification of patients with low coronary artery disease (CAD) prevalence, its value in higher risk populations remains unknown.

      Methods

      CORE320 enrolled patients referred for invasive coronary angiography with known or suspected CAD. Coronary computed tomography angiography (CCTA) images were collected for 381 patients for whom clinical outcomes were assessed 5 years after enrollment. Using semi-automated image analysis software, PCAT was obtained and normalized for the right coronary (RCA), left anterior descending (LAD), and left circumflex arteries (LCx). The association between PCAT and major adverse cardiovascular events (MACE) during follow up was assessed using Cox regression models.

      Results

      Thirty-seven patients were excluded due to technical failure. For the remaining 344 patients, median age was 62 (interquartile range, 55–68) with 59% having ≥1 coronary artery stenosis of ≥50% by quantitative coronary angiography. Mean attenuation values for PCAT in RCA, LAD, and LCx were −74.9, −74.2, and −71.2, respectively. Hazard ratios and 95% confidence intervals (CI) for normalized PCAT in the RCA, LAD, and LCx for MACE were 0.96 (CI: 0.75–1.22, p ​= ​0.71), 1.31 (95% CI: 0.96–1.78, p ​= ​0.09), and 0.98 (95% CI: 0.78–1.22, p ​= ​0.84), respectively. For death, stroke, or myocardial infarction only, hazard ratios were 0.68 (0.44–1.07), 0.85 (0.56–1.29), and 0.57 (0.41–0.80), respectively.

      Conclusions

      In patients referred for invasive coronary angiography with suspected CAD, PCAT did not predict MACE during long term follow up. Further studies are needed to understand the relationship of PCAT with CAD risk.

      Keywords

      Abbreviations:

      AUC (area under receiver operator characteristics curve), CABG (coronary artery bypass grafting), CAD (coronary artery disease), CCTA (coronary computed tomography angiogram), CI (confidence interval), HR (hazard ratio), HU (Hounsfield units), ICA (invasive coronary angiography), LAD (left anterior descending artery), LCx (left circumflex artery), MACE (major adverse cardiovascular events), MI (myocardial infarction), PCI (percutaneous coronary intervention), PCAT (pericoronary adipose tissue attenuation), RCA (right coronary artery)
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