Key result
High pericoronary FAI linked to ~5-fold greater MACE risk in diabetics with non-obstructive CAD.
Why the study?
Non-obstructive CAD is prevalent in diabetic patients, but evidence-based risk stratification recommendations are limited, prompting evaluation of the incremental prognostic value of pericoronary FAI beyond CCTA parameters and CT-FFR.
Does pericoronary fat attenuation index (FAI) improve prognostic prediction of MACE beyond standard CCTA parameters in diabetic patients with non-obstructive CAD?
Does pericoronary fat attenuation index (FAI) improve prognostic prediction of MACE beyond standard CCTA parameters in diabetic patients with non-obstructive CAD?
Pericoronary FAI provides significant incremental prognostic value beyond high-risk plaque features and CT-FFR for predicting MACE in diabetic patients with non-obstructive CAD.
May enhance MACE prediction in diabetic non-obstructive CAD; extends observational data but leaves open prospective validation.
Non-obstructive coronary artery disease (CAD) is highly prevalent in diabetic patients, yet there are currently limited evidence-based recommendations for risk stratification and management in this population. We aimed to investigate the additional prognostic value of pericoronary fat attenuation index (FAI) beyond coronary computed tomography angiography (CCTA) parameters and CCTA-derived fractional flow reserve (CT-FFR) in diabetic patients with non-obstructive CAD. 310 diabetic patients with non-obstructive CAD (coronary stenosis 1–49% on CCTA) between January 2017 and December 2018 were retrospectively enrolled. Clinical data, CCTA parameters, CT-FFR, and pericoronary FAI of patients were collected. Major adverse cardiovascular events (MACE) included rehospitalization for unstable angina, non-fatal myocardial infarction, late coronary revascularization, and cardiac death. During a median follow-up of 71 (65, 78) months, 35 patients experienced MACE. Multivariate Cox regression analysis showed that high-risk plaque (HRP) [hazard ratio (HR) = 4.323; 95% confidence interval (CI): 1.978–9.451; p < 0.001], CT-FFR ≤ 0.80 (HR = 2.622; 95% CI: 1.021–6.732; p = 0.045), and pericoronary FAI > − 73.87 HU (HR = 5.074; 95% CI: 2.191–11.751; p < 0.001) were independent predictors of MACE. Adding pericoronary FAI to the model including HRP and CT-FFR significantly improved area under the curve from 0.665 to 0.783 ( p = 0.006). Similar results were observed when major adverse cardiovascular and cerebrovascular events were used for sensitivity analysis. Pericoronary FAI was an independent predictor of MACE in diabetic patients with non-obstructive CAD, and it provided incremental prognostic value beyond HRP and CT-FFR.
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Qin et al. (2026) studied this question. Pericoronary fat attenuation index > −73.87 HU was an independent predictor of MACE with HR 5.074, providing significant incremental prognostic value in diabetic patients with non-obstructive CAD.
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