Association of Pericoronary Adipose Attenuation With Major Adverse Cardiovascular Events and High-Risk Plaque

Abstract

Background: The characterization of pericoronary adipose tissue (PCAT) attenuation may provide adjunctive prognostic information to coronary evaluation at coronary computed tomography angiography. However, heterogeneity in measurement methodologies has led to uncertainties regarding its clinical applicability.

Objectives: This systematic review and meta-analysis explores the impact of measurement methodology on the association between PCAT and major adverse cardiac events (MACE) and high-risk plaque (HRP).

Methods: Studies linking PCAT to MACE and HRP were searched in online databases. Quantitative meta-analysis was only performed where univariable HR estimates were reported, and random effects modelling with 95% CIs are reported. Qualitative synthesis was performed where multivariable estimates were reported.

Results: There were 17 studies (N = 10,482) included. Quantitative analysis was performed in 8,396 patients, all with stable coronary artery disease; elevated right coronary artery (RCA)-PCAT attenuation was associated with MACE (HR: 1.22 [95% CI: 1.08-1.38]; P = 0.001), with weak significance in left circumflex-PCAT (HR: 1.03 [95% CI: 1.01-1.05]; P = 0.014), and left anterior descending artery-PCAT did not meet significance (HR: 1.01 [95% CI: 0.98-1.05]; P = 0.47). No quantitative synthesis was possible for association with HRP. Qualitatively, studies have shown a positive and significant association with RCA-PCAT and HRP (HR range: 1.03-5.62). Although studies adjusted for different risk modifiers in multivariable models, a positive association was found despite different measurement methodology (mean PCAT, fat attenuation index) and minor differences in study-defined cutoffs for elevated RCA-PCAT attenuation.

Conclusions: Although the strength of associations varied by measurement technique, PCAT is associated with MACE and high-risk plaque.

Keywords: coronary computed tomography angiography; inflammation; major adverse cardiovascular events; pericoronary adipose tissue; plaque.