Relationship Between Pericoronary Fat Attenuation Index on Baseline CT and Target Vessel Revascularization in Patients After Percutaneous Coronary Intervention

Objective: To investigate the association of the pericoronary fat attenuation index (FAI) derived from coronary computed tomography angiography (CCTA) with target vessel revascularization (TVR) in symptomatic postprocedure patients. Methods: A retrospective analysis was conducted, including 154 patients with 191 lesions scheduled for stenting who underwent invasive coronary angiography (ICA) after preinterventional CCTA. The proximal pericoronary FAI of the 3 major coronary arteries and lesion-specific pericoronary FAI were measured on preprocedure CCTA using semi-automated software. Lesions were randomly allocated to a training set (n=133) and a test set (n=58). Multivariate logistic regression analyses were performed to identify independent variables associated with TVR in the training cohort. Analyses were performed on the patient and vessel levels. Results: A total of 154 patients (age 60.9±9.5 y, 68.8% male) with 191 lesions scheduled for stenting were included. On the basis of patient-level analysis, patients with TVR showed higher pericoronary FAI compared with patients without TVR. In vessel-level analysis, the regression model incorporating 1 cm 2 mm lesion-specific pericoronary FAI demonstrated superior diagnostic performance in both cohorts (training set AUC 0.814, 95% CI: 0.721-0.907; test set AUC 0.794, 95% CI: 0.659-0.928). The optimal cutoff value of −70.49 HU for the 1 cm 2 mm lesion-specific pericoronary FAI was determined by maximizing Youden’s index, achieving a sensitivity of 75.0% and specificity of 63.0% in the test set. The model exhibited excellent calibration and clinical utility as confirmed by calibration curves and decision curve analysis (DCA). Multivariate logistic regression analysis showed that 1 cm 2 mm lesion-specific pericoronary FAI (OR 1.2, 95% CI: 1.01-1.42, P =0.036) was an independent predictor of TVR. Conclusions: CCTA-derived pericoronary FAI is significantly associated with TVR in postprocedural patients. The 1 cm 2 mm lesion-specific pericoronary FAI, with an optimal cutoff of −70.49 HU, represents an effective tool for TVR risk stratification in this patient population.