High levels of pericoronary adipose tissue inflammation are associated with coronary atherosclerosis independent of epicardial adipose tissue volume in patients with chronic coronary syndrome

Aims This study aimed to assess clinical risks and coronary atherosclerotic burden in patients with chronic coronary syndrome (CCS) stratified by pericoronary artery adipose tissue (PCAT) composition and epicardial adipose tissue volume (EAV). Methods and results We retrospectively included 410 CCS patients who underwent coronary computed tomography angiography. Patients were divided into four groups based on an EAV index ≥ 73.5 mL/mm2 and PCAT attenuation (PCATA) in the right coronary artery (PCATARCA) ≥ −76.6 HU (above median); Groups A (low EAV index and low PCATARCA), B (low EAV index and high PCATARCA), C (high EAV index and low PCATARCA), and D (high EAV index and high PCATARCA). Multivariable models assessed the relative risk of coronary artery calcium score (CACS) > 400 and coronary artery disease (CAD), and predictors of coronary plaque volume. The log-transformed CACS increased progressively, with Group D showing the highest values. Group D had the highest prevalence of Hisayama risk score of 10-year risk > 10%, CACS > 400, and CAD. The high EAVi group (C and D) showed increased risks of CACS > 400 [Group C: adjusted odds ratio, 6.30; 95% confidence interval (CI), 1.39–28.6; Group D: adjusted odds ratio, 9.13; 95% CI, 2.00–41.5] and CAD (Group C: adjusted odds ratio, 2.33; 95% CI, 1.13–4.83; Group D: adjusted odds ratio, 9.13; 95% CI, 2.00–41.5). Multivariate linear regression analysis demonstrated that PCATARCA was associated with a greater plaque volume independent of EAV index. Conclusion Elevated PCAT inflammation is associated with the coronary plaque burden independent of EAV index in patients with CCS. Lay summary • This study demonstrates that distinct phenotypes based on ectopic fat volume and composition—the volume of epicardial adipose tissue (EAT) and the inflammation status of pericoronary adipose tissue (PCAT)—can characterize coronary atherosclerotic disease burden in patients with chronic coronary syndrome. • While both increased EAT volume and PCAT inflammation have been reportedly associated with coronary artery disease (CAD) and cardiovascular events, evidence investigating the association of EAT volume and PCAT inflammation with CAD disease burden is limited. • Patients with increased EAT volume are at an elevated risk for coronary artery calcification and increased plaque burden, regardless of PCAT inflammation. In contrast, among patients without increased EAT volume, increased PCAT inflammation is correlated with an increased risk of coronary artery calcification and plaque burden.