Pericoronary fat attenuation index on coronary CT angiography and cardiovascular risk in patients with coronary artery disease and chronic kidney disease

Q: What does this research mean for the field?

High pericoronary fat attenuation index across major coronary arteries is independently associated with an increased risk of major adverse cardiovascular events, cardiovascular mortality, and all-cause mortality in patients with concurrent coronary artery disease and chronic kidney disease. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Xiaozhao Lu; Wei Pan; Weitao Ye; Ziyao Yuan; Huangtao Ruan; Haozhang Huang; Weipeng Zhang; Chenyang Wang; Yu Kang; Jing Hu; Zeliang Li; Jingru Deng; Yingying Li; Wanying Wu; Wai‐Kit Ming; Chun‐Ka Wong; Ning Tan; Shiqun Chen; Jin Liu; Ji-yan Chen; Yong Liu

doi:10.1186/s12882-025-04549-7

Why the study?

The prognostic significance of the pericoronary fat attenuation index in patients with concurrent CAD and CKD remained uncertain.

Does a high pericoronary fat attenuation index (pFAI) on CCTA predict an increased risk of MACEs and mortality in patients with concurrent CAD and CKD?

Structured PICO

Does a high pericoronary fat attenuation index (pFAI) on CCTA predict an increased risk of MACEs and mortality in patients with concurrent CAD and CKD?

P

Population

444 patients with concurrent coronary artery disease (CAD) and chronic kidney disease (CKD) who underwent coronary computed tomography angiography (CCTA) within 1 year of invasive coronary angiography, mean age 70.7 ± 9.6 years, 32% female.

I

Intervention

High pericoronary fat attenuation index (pFAI) measured around the proximal 40 mm of the left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA)

C

Comparator

Low pericoronary fat attenuation index (pFAI) levels

O

Outcome

Major adverse cardiovascular events (MACEs), including cardiovascular mortality, nonfatal myocardial infarction and strokecomposite

A high pericoronary fat attenuation index on CCTA is independently associated with an increased risk of MACEs and mortality in patients with concurrent CAD and CKD, highlighting its potential as an imaging biomarker for risk stratification.

Implication

pFAI may refine risk stratification in CAD with CKD; leaves open prospective validation before clinical use.

Abstract

BACKGROUND: The pericoronary fat attenuation index (pFAI), derived from coronary computed tomography angiography (CCTA), is an emerging marker of local inflammation of coronary arteries. Its prognostic significance in patients with coronary artery disease (CAD) and chronic kidney disease (CKD), which share common inflammatory pathways, remains uncertain. This study aimed to assess the associations between the pFAI and cardiovascular and mortality risk in patients with concurrent CAD and CKD. METHODS: Patients with both CAD and CKD who underwent CCTA within 1 year of invasive coronary angiography were included from Cardiorenal Improvement-Ⅱ. The pFAI was measured around the proximal 40 mm of the left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). High pFAI values were determined from the median levels of LAD (-81.0 HU), LCX (-78.8 HU) and RCA (-79.4 HU). The primary outcome was major adverse cardiovascular events (MACEs), including cardiovascular mortality, nonfatal myocardial infarction and stroke, and the secondary outcomes were cardiovascular and all-cause mortality. Multivariate Cox proportional hazards regression analysis was used to investigate the associations between pFAI and MACEs and cardiovascular and all-cause mortality. RESULTS: A total of 444 patients (mean age 70.7 ± 9.6 years, 32% female) were included, and 90 (20.3%) cases of MACE, 68 (15.3%) cases of cardiovascular mortality, and 125 (28.2%) cases of all-cause mortality occurred, with a median follow-up of 4.57 years. For MACEs in patients with high pFAI levels compared with those with low pFAI levels, the multivariable adjusted HR was 1.65 (95% CI: 1.02-2.66; P = 0.042) for LAD, 2.06 (95% CI: 1.23-3.45; P = 0.006) for LCX, and 1.71 (95% CI: 1.07-2.74; P = 0.025) for RCA. For cardiovascular and all-cause mortality, similar significant associations were observed (all P < 0.05). CONCLUSIONS: A high pFAI for each major coronary artery was independently associated with an increased risk of MACEs and cardiovascular and all-cause mortality in patients with CAD and CKD.