Factors Associated With Atherosclerosis, Ischemia More Stron
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This study was designed to assess the prognostic value of pericoronary adipose tissue computed tomography attenuation (PCATa) beyond quantitative coronary computed tomography angiography (CCTA)–derived plaque volume and positron emission tomography (PET) determined ischemia.

Inflammation plays a crucial role in atherosclerosis. PCATa has been shown to assess coronary-specific inflammation and is of prognostic value in patients with suspected coronary artery disease (CAD).

A total of 539 patients who underwent CCTA and [15O]H2O PET perfusion imaging because of suspected CAD were included. Imaging assessment included coronary artery calcium score (CACS), presence of obstructive CAD (more than 50% stenosis) and high-risk plaques (HRPs), total plaque volume (TPV), calcified/noncalcified plaque volume (CPV/NCPV), PCATa, and myocardial ischemia. The endpoint was a composite of death and nonfatal myocardial infarction. Prognostic thresholds were determined for quantitative CCTA variables.

-- During a median follow-up of 5.0 years, 33 events occured. CACS more than 59 Agatston units, obstructive CAD, HRPs, TPV more than 220 mm3, CPV more than 110 mm3, NCPV more than 85 mm3, and myocardial ischemia were associated with shorter time to the endpoint with unadujsted hazard ratios (HRs) of 4.17, 4.88, 3.41, 7.91, 5.82, 8.07, and 4.25, respectively.

-- Right coronary artery (RCA) PCATa above scanner specific thresholds was associated with worse prognosis, whereas left anterior descending artery and circumflex artery PCATa were not related to outcome.

-- RCA PCATa above scanner specific thresholds retained is prognostic value adjusted for imaging variables and clinical characteristics associated with the endpoint.

Conclusively, parameters associated with atherosclerotic burden and ischemia were more strongly associated with outcome than RCA PCATa. Nonetheless, RCA PCATa was of prognostic value beyond clinical characteristics, CACS, obstructive CAD, HRPs, TPV, CPV, NCPV, and ischemia.

Source: https://www.jacc.org/doi/10.1016/j.jcmg.2021.02.026?_ga=2.153543288.1560520914.1620818508-777820309.1584504539