Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The Netherlands.
First Department of Cardiology, Medical School, AHEPA Hospital, Aristotle University of Thessaloniki, , St. Kiriakidi 1, Thessaloniki GR-54636, Greece.
Eur Heart J Cardiovasc Imaging. 2024 Sep 30;25(10):1351-1359. doi: 10.1093/ehjci/jeae197.
Pericoronary adipose tissue (PCAT) attenuation obtained by coronary computed tomography angiography (CCTA) has been associated with coronary inflammation and outcomes. Whether PCAT attenuation is predictive of major adverse cardiac events (MACE) during long-term follow-up is unknown.
Symptomatic patients with coronary artery disease (CAD) who underwent CCTA were included, and clinical outcomes were evaluated. PCAT was measured at all lesions for all three major coronary arteries using semi-automated software. A comparison between patients with and without MACE was made on both a per-lesion and a per-patient level. The predictive value of PCAT attenuation for MACE was assessed in Cox regression models. In 483 patients (63.3 ± 8.5 years, 54.9% men), 1561 lesions were analysed over a median follow-up duration of 9.5 years. The mean PCAT attenuation was not significantly different between patients with and without MACE. At a per-patient level, the adjusted hazard ratio (HR) and 95% confidence interval (CI) for MACE were 0.970 (95% CI: 0.933-1.008, P = 0.121) when the average of all lesions per patient was analysed, 0.992 (95% CI: 0.961-1.024, P = 0.622) when only the most obstructive lesion was evaluated, and 0.981 (95% CI: 0.946-1.016, P = 0.285) when only the lesion with the highest PCAT attenuation per individual was evaluated. Adjusted HRs for vessel-specific PCAT attenuation in the right coronary artery, left anterior descending artery, and left circumflex artery were 0.957 (95% CI: 0.830-1.104, P = 0.548), 0.989 (95% CI: 0.954-1.025, P = 0.550), and 0.739 (95% CI: 0.293-1.865, P = 0.522), respectively, in predicting long-term MACE.
In patients referred to CCTA for clinically suspected CAD, PCAT attenuation did not predict MACE during long-term follow-up.
通过冠状动脉计算机断层扫描血管造影术（CCTA）获得的冠状动脉周围脂肪组织（PCAT）衰减与冠状动脉炎症和结局相关。在长期随访中，PCAT 衰减是否可预测主要不良心脏事件（MACE）尚不清楚。
纳入因疑似冠心病而行 CCTA 的症状性患者，并评估其临床结局。使用半自动软件对所有 3 大冠状动脉的所有病变进行 PCAT 测量。比较了有无 MACE 患者的病变和患者水平。使用 Cox 回归模型评估 PCAT 衰减对 MACE 的预测价值。在 483 例患者（63.3 ± 8.5 岁，54.9%为男性）中，对 1561 个病变进行了中位随访时间为 9.5 年的分析。有无 MACE 患者之间的平均 PCAT 衰减无显著差异。在患者水平上，当分析每位患者所有病变的平均值时，MACE 的调整后的危险比（HR）和 95%置信区间（CI）为 0.970（95%CI：0.933-1.008，P = 0.121），当仅评估最阻塞性病变时，为 0.992（95%CI：0.961-1.024，P = 0.622），当仅评估每位患者 PCAT 衰减最高的病变时，为 0.981（95%CI：0.946-1.016，P = 0.285）。右冠状动脉、前降支和左旋支血管特异性 PCAT 衰减的调整 HR 分别为 0.957（95%CI：0.830-1.104，P = 0.548）、0.989（95%CI：0.954-1.025，P = 0.550）和 0.739（95%CI：0.293-1.865，P = 0.522），分别预测长期 MACE。
在因疑似冠心病而行 CCTA 检查的患者中，PCAT 衰减在长期随访中不能预测 MACE。
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