Impact of pericoronary adipose tissue attenuation on clinical outcomes after percutaneous coronary intervention

Abstract

Background: Pericoronary adipose tissue (PCAT) attenuation, measured using coronary computed tomography angiography (cCTA), is a potential marker of coronary inflammation.

Aims: We aimed to examine the association between coronary inflammation, as assessed by measuring PCAT attenuation before percutaneous coronary intervention (PCI), and clinical outcomes of PCI using current-generation drug-eluting stents (DES).

Methods: We retrospectively studied consecutive patients who underwent cCTA before PCI with current-generation DES. Adverse plaque characteristics, calcified plaque (CP) burden, and PCAT attenuation of the proximal right coronary artery (PCAT_RCA) were assessed using cCTA. The primary outcome was a patient-oriented composite endpoint (PoCE), including cardiovascular death, non-fatal myocardial infarction, any revascularisation, and stroke.

Results: During a median follow-up of 1,540 days, 77 of 490 patients experienced PoCE. Patients with PoCE had higher PCAT_RCA (−76.3±6.4 Hounsfield units [HU] vs −82.5±8.1 HU; p<0.001). Multivariable analysis showed that the presence of adverse plaque, greater CP burden and higher PCAT_RCA were independently associated with PoCE (hazard ratio [HR] 2.05, 95% confidence interval [CI]: 1.26-3.34; p=0.004; HR 1.04, 95% CI: 1.02-1.07; p=0.002; and HR 2.20, 95% CI: 1.63-2.97; p<0.001, respectively). PoCE incidence was 3.9 times higher in patients with high PCAT_RCA (≥−79.9 HU) than those with low PCAT_RCA (<−79.9 HU). Adding PCAT_RCA to traditional cardiovascular risk factors and cCTA findings (adverse plaque and CP burdens) improved the predictive and reclassification abilities for PoCE.

Conclusions: High PCAT_RCA was independently associated with PoCE after PCI using current-generation DES. Combining PCAT_RCA with traditional cardiovascular risk factors and cCTA findings may enhance risk assessment for PoCE after PCI.