TY - JOUR
T1 - Pericoronary Adipose Tissue Attenuation, Low-Attenuation Plaque Burden, and 5-Year Risk of Myocardial Infarction
AU - Tzolos, Evangelos
AU - Williams, Michelle C.
AU - McElhinney, Priscilla
AU - Lin, Andrew
AU - Grodecki, Kajetan
AU - Flores Tomasino, Guadalupe
AU - Cadet, Sebastien
AU - Kwiecinski, Jacek
AU - Doris, Mhairi
AU - Adamson, Philip D.
AU - Moss, Alastair J.
AU - Alam, Shirjel
AU - Hunter, Amanda
AU - Shah, Anoop S.V.
AU - Mills, Nicholas L.
AU - Pawade, Tania
AU - Wang, Chengjia
AU - Weir-McCall, Jonathan R.
AU - Roditi, Giles
AU - van Beek, Edwin J.R.
AU - Shaw, Leslee J.
AU - Nicol, Edward D.
AU - Berman, Daniel S.
AU - Slomka, Piotr J.
AU - Dweck, Marc R.
AU - Newby, David E.
AU - Dey, Damini
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/6
Y1 - 2022/6
N2 - 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.
AB - 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.
KW - computed tomography angiography
KW - coronary artery disease
KW - low-attenuation noncalcified plaque burden
KW - noncalcified plaque burden
KW - pericoronary adipose tissue
KW - risk stratification
UR - http://www.scopus.com/inward/record.url?scp=85130913379&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2022.02.004
DO - 10.1016/j.jcmg.2022.02.004
M3 - Article
C2 - 35450813
AN - SCOPUS:85130913379
SN - 1936-878X
VL - 15
SP - 1078
EP - 1088
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 6
ER -