Key result
High perivascular fat attenuation index linked to ~19-fold higher MACE risk in young suspected CAD patients.
Why the study?
The perivascular fat attenuation index (FAI) by CCTA has strong prognostic value, but few studies have evaluated it in young people suspected of CAD.
Does a high perivascular fat attenuation index predict major adverse cardiac events in young adults suspected of having coronary artery disease?
Cohort (n=503)
No
Does a high perivascular fat attenuation index predict major adverse cardiac events in young adults suspected of having coronary artery disease?
In young adults suspected of CAD, a high perivascular fat attenuation index on CCTA significantly improves the prediction of long-term major adverse cardiac events over traditional risk factors.
Answers are grounded in this paper and cite their sources.
High FAI may refine MACE prediction in young suspected CAD; hypothesis-generating and should not change practice without prospective validation.
OBJECTIVE: The perivascular fat attenuation index (FAI) evaluated by coronary computed tomographic angiography (CCTA) has been reported to have strong prognostic value, but few studies have focused on young people. This study aimed to assess the predictive value of the perivascular FAI in young people suspected of having coronary atherosclerotic disease (CAD). METHOD: A retrospective analysis was performed on adults aged ≤ 45 years who underwent CCTA due to suspected CAD between 2015 and 2016 and who were followed up for at least 5 years following their visit (n = 503). The perivascular FAI at the proximal segment of the right coronary artery (RCA) was measured and grouped into high FAI and low FAI according to the optimal cut-off value, and the association between a high FAI and major adverse cardiac events (MACE) was evaluated by Cox hazard regression. K‒M survival analysis was conducted to assess the prognostic value of the perivascular FAI and improvement over traditional risk factor prediction methods. RESULTS: The event-free survival of patients in the high FAI group (FAI≥-75.2 HU) was significantly lower than that of patients in the low FAI group (FAI<-75.2 HU) at a median follow-up of 72.7 months (93.9% vs. 99.7%, P < 0.001). A high FAI (HR = 19.257, 95% CI: 2.504-148.107, P = 0.004) showed a significant correlation with an increased risk of MACE in young people. The prediction accuracy of MACE can be improved by including a high FAI on the basis of the traditional risk factor model, and the area under the curve (AUC) increased from 0.728 to 0.845 (P < 0.001). Moreover, the new model revealed significant improvements in integrated discrimination (IDI = 0.033, 95% CI: 0.009-0.103, P = 0.014) and the net reclassification index (NRI = 0.597, 95% CI: 0.000-0.699, P = 0.024). CONCLUSION: The high perivascular FAI at the proximal segment of the RCA is significantly associated with an increased risk of long-term MACE and may be a potential tool for cardiovascular risk stratification in young people suspected of CAD.
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Yu et al. (2025) conducted a cohort in Suspected coronary artery disease (n=503). High perivascular fat attenuation index (FAI ≥ -75.2 HU) vs. Low perivascular fat attenuation index (FAI < -75.2 HU) was evaluated on Major adverse cardiac events (MACE) (HR 19.257, 95% CI 2.504-148.107, p=0.004). A high perivascular fat attenuation index (≥-75.2 HU) was significantly associated with an increased risk of major adverse cardiac events (HR 19.257) in young people suspected of coronary artery disease.
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