EATV, EAT-CT Attenuation, and PACT-FAI as Predictors of Dual Cardiovascular Outcomes: Postoperative Atrial Fibrillation and Graft Occlusion

OBJECTIVE: To evaluate the predictive value of epicardial adipose tissue volume (EATV), EAT-CT attenuation, and pericoronary adipose tissue fat attenuation index (PCAT-FAI) for postoperative atrial fibrillation (POAF) and graft occlusion after coronary artery bypass grafting (CABG). METHODS: In this single-center retrospective study, 83 patients undergoing CABG with preoperative CCTA were enrolled. EATV, EAT-CT attenuation, pericoronary adipose tissue volume (PCAT volume), and PCAT-FAI were measured. Multivariate logistic regression and ROC analysis were used to assess their predictive performance. RESULTS: During a 13-month follow-up, 20.4% developed POAF and 39.8% had graft occlusion. The combination of EATV, EAT-CT attenuation, and PCAT-RCA-FAI predicted POAF with an AUC of 0.880, superior to any single parameter. It also showed improved prediction for graft occlusion (AUC=0.814). CONCLUSION: EATV, EAT-CT attenuation, and PCAT-RCA-FAI provide complementary predictive value for POAF and graft occlusion after CABG. Combined use improves preoperative risk stratification and supports clinical decision-making.