Pericoronary Adipose Tissue Attenuation in Patients with Future Acute Coronary Syndromes: The ICONIC Study

Alan C Kwan; Evangelos Tzolos; Eyal Klein; Donghee Han; Andrew Lin; Keiichiro Kuronuma; Billy Chen; Guadalupe Flores Tomasino; Heidi Gransar; Piotr J Slomka; Susan Cheng; Catherine Gebhard; Philipp Kaufmann; Jeroen J Bax; Filippo Cademartiri; Kavitha Chinnaiyan; Benjamin J W Chow; Edoardo Conte; Ricardo C Cury; Gudrun Feuchtner; Martin Hadamitzky; Yong-Jin Kim; Jonathon A Leipsic; Erica Maffei; Hugo Marques; Fabian Plank; Gianluca Pontone; Todd C Villines; Mouaz H Al-Mallah; Pedro de Araújo Gonçalves; Ibrahim Danad; Yao Lu; Ji-Hyun Lee; Sang-Eun Lee; Lohendran Baskaran; Subhi J Al'Aref; Matthew J Budoff; Habib Samady; Peter H Stone; Renu Virmani; Stephan Achenbach; Jagat Narula; Hyuk-Jae Chang; Leslee J Shaw; Daniel S Berman; Fay Lin; Damini Dey

doi:Purpose Pericoronary adipose tissue attenuation (PCATa) measured at coronary CT angiography (CCTA) is an imaging biomarker of coronary inflammation associated with long-term adverse cardiac events. The authors hypothesized that PCATa may independently identify patients at risk for acute coronary syndromes (ACS). Materials and Methods The authors performed a retrospective substudy of the Incident Coronary Syndromes Identified by Computed Tomography (ICONIC) study, a propensity-matched case-control study of patients with CCTA followed by ACS. Two hundred analyzable case and control pairs were identified from the original 234 pairs. PCATa was measured using the adjusted attenuation of fat around proximal coronary vessels. The primary analysis applied conditional Cox models with cluster-robust standard errors to predict patient-level incident ACS, with adjustment for quantitative plaque volumes and clinical reporting-oriented findings of maximal stenosis and high-risk plaque features (HRPF). Results A total of 400 patients with 1174 matched measurable vessels were included. PCATa was not significantly different between patients with future ACS versus controls (-72.99 HU ± 9.42 vs -73.96 HU ± 9.47; P = .08). Conversely, PCATa was significantly associated with incident ACS events in Cox models (adjusted for noncalcified plaque hazard ratio [HR]: 1.015; 95% CI: 1.001, 1.028; P = .03; adjusted for total plaque HR: 1.015; 95% CI: 1.002, 1.029; P = .03; adjusted for stenosis and HRPF HR: 1.014; 95% CI: 1.000, 1.028; P = .049). Conclusion Limited quantitative difference in PCATa between patients and controls matched for risk factors and coronary artery disease suggests that PCATa may not be a useful single marker to identify future ACS. Nonetheless, significant differences seen in adjusted survival models identify a small biologic effect for increased risk of future ACS independent of traditional risk factors.

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Pericoronary Adipose Tissue Attenuation in Patients with Future Acute Coronary Syndromes: The ICONIC Study

Authors: Alan C Kwan ; Evangelos Tzolos ; Eyal Klein ; Donghee Han ; Andrew Lin ; Keiichiro Kuronuma ; Billy Chen ; Guadalupe Flores Tomasino ; Heidi Gransar ; Piotr J Slomka ; Susan Cheng ; Catherine Gebhard ; Philipp Kaufmann ; Jeroen J Bax ; Filippo Cademartiri ; Kavitha Chinnaiyan ; Benjamin J W Chow ; Edoardo Conte ; Ricardo C Cury ; Gudrun Feuchtner ; Martin Hadamitzky ; Yong-Jin Kim ; Jonathon A Leipsic ; Erica Maffei ; Hugo Marques ; Fabian Plank ; Gianluca Pontone ; Todd C Villines ; Mouaz H Al-Mallah ; Pedro de Araújo Gonçalves ; Ibrahim Danad ; Yao Lu ; Ji-Hyun Lee ; Sang-Eun Lee ; Lohendran Baskaran ; Subhi J Al'Aref ; Matthew J Budoff ; Habib Samady ; Peter H Stone ; Renu Virmani ; Stephan Achenbach ; Jagat Narula ; Hyuk-Jae Chang ; Leslee J Shaw ; Daniel S Berman ; Fay Lin ; Damini Dey

Citation: RADIOLOGY-CARDIOTHORACIC IMAGING, Vol.7(3) : e240200, 2025-06

Journal Title: RADIOLOGY-CARDIOTHORACIC IMAGING

Issue Date: 2025-06

MeSH: 1

Keywords: Acute Coronary Syndrome* / diagnostic imaging ; Adipose Tissue* / diagnostic imaging ; Aged ; Case-Control Studies ; Computed Tomography Angiography* / methods ; Coronary Angiography* / methods ; Coronary Vessels / diagnostic imaging ; Epicardial Adipose Tissue ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies

Abstract: Acute Coronary Syndrome ; CT-Angiography ; Cardiovascular Risk ; Coronary Arteries ; ICONIC Study ; Inflammation ; Noncalcified Plaque ; Pericoronary Adipose Tissue Attenuation

Article Number: 10.1148/ryct.240200

DOI: Purpose Pericoronary adipose tissue attenuation (PCATa) measured at coronary CT angiography (CCTA) is an imaging biomarker of coronary inflammation associated with long-term adverse cardiac events. The authors hypothesized that PCATa may independently identify patients at risk for acute coronary syndromes (ACS). Materials and Methods The authors performed a retrospective substudy of the Incident Coronary Syndromes Identified by Computed Tomography (ICONIC) study, a propensity-matched case-control study of patients with CCTA followed by ACS. Two hundred analyzable case and control pairs were identified from the original 234 pairs. PCATa was measured using the adjusted attenuation of fat around proximal coronary vessels. The primary analysis applied conditional Cox models with cluster-robust standard errors to predict patient-level incident ACS, with adjustment for quantitative plaque volumes and clinical reporting-oriented findings of maximal stenosis and high-risk plaque features (HRPF). Results A total of 400 patients with 1174 matched measurable vessels were included. PCATa was not significantly different between patients with future ACS versus controls (-72.99 HU ± 9.42 vs -73.96 HU ± 9.47; P = .08). Conversely, PCATa was significantly associated with incident ACS events in Cox models (adjusted for noncalcified plaque hazard ratio [HR]: 1.015; 95% CI: 1.001, 1.028; P = .03; adjusted for total plaque HR: 1.015; 95% CI: 1.002, 1.029; P = .03; adjusted for stenosis and HRPF HR: 1.014; 95% CI: 1.000, 1.028; P = .049). Conclusion Limited quantitative difference in PCATa between patients and controls matched for risk factors and coronary artery disease suggests that PCATa may not be a useful single marker to identify future ACS. Nonetheless, significant differences seen in adjusted survival models identify a small biologic effect for increased risk of future ACS independent of traditional risk factors.

Appears in Collections:: 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers

Yonsei Authors: Chang, Hyuk-Jae(장혁재) https://orcid.org/0000-0002-6139-7545

URI: https://ir.ymlib.yonsei.ac.kr/handle/22282913/207540

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