Prognostic value of serial coronary computed tomography angiography-derived perivascular fat-attenuation index and plaque volume in patients with suspected coronary artery disease

X Sun; Y Zhu; N Zhang; K Yuan; J Ling; J Ye

doi:10.1016/j.crad.2024.04.007

Prognostic value of serial coronary computed tomography angiography-derived perivascular fat-attenuation index and plaque volume in patients with suspected coronary artery disease

Clin Radiol. 2024 Apr 21:S0009-9260(24)00198-3. doi: 10.1016/j.crad.2024.04.007. Online ahead of print.

Authors

X Sun¹, Y Zhu¹, N Zhang¹, K Yuan², J Ling³, J Ye⁴

Affiliations

¹ Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University, Yangzhou, PR China.
² Department of Cadiology, Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University, Yangzhou, PR China.
³ Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University, Yangzhou, PR China. Electronic address: sbrmyylj@163.com.
⁴ Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University, Yangzhou, PR China. Electronic address: sbrmyyyj@163.com.

PMID: 38755080
DOI: 10.1016/j.crad.2024.04.007

Abstract

Aims: To investigate the prognostic value of serial coronary computed tomography angiography (CCTA) derived plaque information, fractional flow reserve (CT-FFR), and perivascular fat-attenuation index (FAI) on major adverse cardiac events (MACE) in patients with suspected coronary artery disease.

Materials and methods: A total of 252 patients who underwent serial CCTA between January 2018 and December 2021 and were followed until June 2022. MACE were recorded. The analysis indexes included percent diameter stenosis (%DS), lesion length, plaque volume, CT-FFR, and FAI, with an emphasis on their changes between the baseline and follow-up CCTAs. Multivariate regression analysis were employed to identify independent risk factors for MACE.

Results: After a median follow-up of 48-month, MACE occurred in 32 patients (12.7%). Patients with MACE displayed more severe stenosis, longer lesions, and larger plaque volumes in both baseline and follow-up CCTAs compared with no-MACE patients (all P<0.05). Patients with MACE displayed more severe stenosis, longer lesion, and larger plaque volume in both baseline and follow-up CCTAs compared with no-MACE patients. In addition, MACE patients also showed lower CT-FFR and higher △CT-FFR. Although FAI was significantly higher in MACE patients at baseline CCTA, FAI was notably increased in MACE patients, and decreased in the no-MACE patients (all P<0.05). Logistic regression analysis showed that ΔFAI, %DS, and plaque volume were independent predictors of MACE, with ΔFAI being the most significant (OR: 16.725, P<0.000). A multivariable model showed a significantly improved C-index of 0.903 (95% confidence interval: 0.836-0.970) for MACE prediction, when compared with single index alone.

Conclusions: Serial CCTA-derived ΔFAI, %DS, and plaque volume are crucial independent predictors of MACE in patients with suspected coronary artery disease, highlighting the importance of CCTA in patient risk stratification and prognostic assessment.