Prognostic Value of Pericoronary Adipose Tissue on ECG-Gated Non-Contrast CT in Patients With Stable Chest Pain: Insights from the PROMISE Trial
Marcel C Langenbach, Ibrahim Hadzic, Isabel L Langenbach, Thomas Mayrhofer, Jan M Brendel, Júlia Karády, Michael T Lu, David Maintz, Svati H Shah, Maros Ferencik, Steven K Grinspoon, Pamela S Douglas, Borek FoldynaAbstract
Aims
To investigate whether computed tomography (CT)-derived pericoronary adipose tissue (PCAT) metrics are associated with coronary artery disease (CAD) characteristics and adverse cardiovascular outcomes in patients with stable chest pain.
Methods and Results
PCAT attenuation and body surface area-indexed PCAT volume were quantified on non-contrast, electrocardiogram (ECG)-gated CT in the PROMISE CT arm. Associations with CAD characteristics were assessed using mixed-effects logistic regression adjusted for technical parameters, atherosclerotic cardiovascular disease (ASCVD) risk score, and body mass index. Cox proportional hazards models evaluated major adverse cardiovascular events (MACE; all-cause death or nonfatal myocardial infarction), with additional adjustment for obstructive CAD. PCAT attenuation and volume were included simultaneously in all models.
Among 3,799 individuals (51% female; mean age 61±8 years), PCAT attenuation and volume were -81.4±6.4 Hounsfield units (HU) and 12.9±3.1 cm3/m2, respectively. Higher (less negative) PCAT attenuation and higher PCAT volume were independently associated with stenosis ≥50% and high-risk plaque (adjusted odds ratios; attenuation: 1.02–1.03 (per 1 HU) and volume: 1.42–1.47 (per 1 cm3/m2); all p≤0.04). Both were independently associated with MACE (adjusted hazard ratios [aHR]: 1.09–1.15; all p≤0.02). PCAT improved MACE discrimination beyond ASCVD risk score, body mass index, and obstructive CAD (area under the curve: 0.70–0.72; p=0.03). In an exploratory analysis among participants without coronary plaque, higher PCAT attenuation remained associated with MACE (aHR 1.21, 95% CI 1.05–1.39; p=0.007).
Conclusion
PCAT metrics, measured on ECG-gated non-contrast CT, are independently associated with adverse CAD features and MACE and provide incremental prognostic value beyond clinical risk factors and obstructive CAD.