Edinburgh Imaging

15 Apr 22. Featured Paper

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

Link to paper on JACC: Cardiovascular Imaging



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 Beek, Leslee J. Shaw, Edward D. Nicol, Daniel S. Berman, Piotr J. Slomka, Marc R. Dweck, David E. Newby, Damini Dey



Objectives: We sought to assess the relative and additive values of pericoronary adipose tissue (PCAT) attenuation and low-attenuation noncalcified plaque (LAP) to predict future risk of myocardial infarction.

Background: PCAT attenuation and LAP burden can both predict outcomes.

Methods: In a post hoc analysis of the multicenter SCOT-HEART (Scottish Computed Tomography of the Heart) trial, we investigated the relationships between the future risk of fatal or nonfatal myocardial infarction and PCAT attenuation measured from computed tomography coronary angiography 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: Computed tomography coronary angiography–defined LAP burden and PCAT attenuation have marked and complementary predictive value for the risk of fatal or nonfatal myocardial infarction.





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