Pericoronary adipose tissue attenuation determined by CT predicts cardiovascular events in patients with suspected coronary artery disease: A retrospective cohort study

Background and Aims: Recent studies showed that pericoronary adipose attenuation (PCATA) on coronary computed tomography angiography (CCTA) is a non-invasive biomarker for pericoronary inflammation. This study aimed to investigate whether PCATA is a useful predictor for cardiovascular events in patients with suspected coronary artery disease (CAD). Methods: A total of 533 patients who underwent clinically indicated CCTA in our institute from August 2011 and December 2015 were enrolled. We assessed PCATA in Hounsfield units (HU) of proximal 40-mm segments of all 3 major coronary arteries. For analyses, the average PCATA of all 3 coroanry arteries was applied. The outcome was the composite of cardiovascular death, acute coronary syndrome, late coronary revascularization. Results: During a median follow-up of 4.7 years, we observed 58 cardiovascular events. PCATA was significantly higher in patients with cardiovascular events than that in patients without cardiovascular events (- 65.3 ± 6.6 HU vs – 67.9 ± 5.7 HU, p=0.02). High PCATA was significantly associated with the incidence of cardiovascular events in a model that included traditional risk factors and adverse CCTA findings, such as significant stenosis and high-risk plaque (hazard ratio; 1.41, 95% confidence interval; 1.08–1.84, p=0.01). Finally, the incremental prognositc value of PCATA was evaluated. After adding PCATA to the prediction model with adverse CCTA findings, global chi-square values increased significantly from 75.4 to 79.3 (p=0.04). Conclusions: In patients with suspected CAD undergoing clinically indicated CCTA, high PCATA could predict cardiovascular events.