Pericoronary adipose tissue attenuation, low-attenuation plaque burden and 5-year risk of myocardial infarction

Evangelos Tzolos, Michelle C Williams, Priscilla McElhinney , Andrew Lin, Kajetan Grodecki, Guadalupe Flores Tomasino, Sebastien Cadet, Jacek Kwiecinski, Mhairi Doris, Philip D Adamson, Alastair J Moss, Shirjel Alam, Amanda Hunter, Anoop S V Shah, Nicholas L Mills, Tania Pawade, Chengjia Wang, Jonathan R Weir-McCall , Giles Roditi, Edwin J R van BeekLeslee J Shaw, Edward D Nicol, Daniel S. Berman, Piotr J Slomka, Marc R Dweck, David E Newby, Damini Dey

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background: Pericoronary adipose tissue (PCAT) attenuation and low-attenuation noncalcified plaque (LAP) burden can both predict outcomes. Objectives: This study sought to assess the relative and additive values of PCAT attenuation and LAP to predict future risk of myocardial infarction. Methods: In a post hoc analysis of the multicenter SCOT-HEART (Scottish Computed Tomography of the Heart) trial, the authors investigated the relationships between the future risk of fatal or nonfatal myocardial infarction and PCAT attenuation measured from coronary computed tomography angiography (CTA) using multivariable Cox regression models including plaque burden, obstructive coronary disease, and cardiac risk score (incorporating age, sex, diabetes, smoking, hypertension, hyperlipidemia, and family history). Results: In 1,697 evaluable participants (age: 58 ± 10 years), there were 37 myocardial infarctions after a median follow-up of 4.7 years. Mean PCAT was −76 ± 8 HU and median LAP burden was 4.20% (IQR: 0%-6.86%). PCAT attenuation of the right coronary artery (RCA) was predictive of myocardial infarction (HR: 1.55; P = 0.017, per 1 SD increment) with an optimum threshold of −70.5 HU (HR: 2.45; P = 0.01). In multivariable analysis, adding PCAT-RCA of ≥−70.5 HU to an LAP burden of >4% (the optimum threshold for future myocardial infarction; HR: 4.87; P < 0.0001) led to improved prediction of future myocardial infarction (HR: 11.7; P < 0.0001). LAP burden showed higher area under the curve compared to PCAT attenuation for the prediction of myocardial infarction (AUC = 0.71 [95% CI: 0.62-0.80] vs AUC = 0.64 [95% CI: 0.54-0.74]; P < 0.001), with increased area under the curve when the 2 metrics are combined (AUC = 0.75 [95% CI: 0.65-0.85]; P = 0.037). Conclusion: Coronary CTA–defined LAP burden and PCAT attenuation have marked and complementary predictive value for the risk of fatal or nonfatal myocardial infarction.

Original languageEnglish
Pages (from-to)1078-1088
JournalJACC: Cardiovascular Imaging
Issue number6
Publication statusPublished - 13 Apr 2022

Keywords / Materials (for Non-textual outputs)

  • Adipose Tissue/diagnostic imaging
  • Aged
  • Computed Tomography Angiography/methods
  • Coronary Angiography/methods
  • Coronary Artery Disease/diagnostic imaging
  • Humans
  • Middle Aged
  • Myocardial Infarction/diagnostic imaging
  • Plaque, Atherosclerotic
  • Predictive Value of Tests


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