Key result
Elevated coronary inflammation linked to ~133% greater long-term MACE risk in non-obstructive CAD.
Why the study?
The influence of sex on coronary inflammation and its impact on clinical outcomes in patients with plaque-positive non-obstructive CAD remains unclear.
Does elevated coronary inflammation (measured by pFAI) and male sex predict worse clinical outcomes in patients with plaque-positive non-obstructive CAD?
Cohort (n=1,395)
Yes
Does elevated coronary inflammation (measured by pFAI) and male sex predict worse clinical outcomes in patients with plaque-positive non-obstructive CAD?
Hazard Ratio: 2.33
p-value: p=<0.001
In patients with plaque-positive non-obstructive CAD, elevated coronary inflammation measured by CCTA-derived pFAI is independently associated with long-term MACE, with males exhibiting higher inflammation and worse outcomes.
BACKGROUND: The influence of sex on coronary inflammation in patients with non-obstructive coronary artery disease (CAD) remains unclear. This study aims to determine sex differences in coronary inflammation, quantified by pericoronary fat attenuation index (pFAI) derived from coronary computed tomography angiography (CCTA), and their impact on clinical outcomes among patients with plaque-positive non-obstructive CAD. METHODS: This study retrospectively included 1395 patients with plaque-positive non-obstructive CAD who underwent CCTA (61±10 years, 55.2% males). Major adverse cardiovascular events (MACEs) were defined as cardiac death, non-fatal myocardial infarction, rehospitalization for heart failure or unstable angina, and late revascularization. RESULTS: After a median follow-up of 85 months (interquartile range [IQR]: 72-99), 177 patients experienced MACEs. Male sex was independently associated with elevated coronary inflammation (pFAI > -70.1 HU; OR=1.36, P=0.047). Male patients had a significantly higher cumulative rate of MACE than female patients (P<0.001). Furthermore, patients with coronary inflammation (pFAI > -70.1 HU) exhibited significantly worse long-term outcomes than those without, and consistent findings were observed in both male and female subgroups (all P<0.001). In multivariable Cox regression analysis, pFAI remained independently associated with MACEs in patients with non-obstructive CAD (HR=2.33, P<0.001) and provided incremental prognostic value beyond clinical variables and traditional CCTA metrics (AUC: 0.683-0.781, P<0.001). CONCLUSION: Among patients with plaque-positive non-obstructive CAD, males exhibited worse long-term outcomes than females and showed a stronger association with coronary inflammation. pFAI is independently associated with long-term prognosis and may enhances risk stratification in these patients.
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Li et al. (2026) conducted a cohort in Plaque-positive non-obstructive coronary artery disease (n=1,395). Coronary inflammation (pFAI > -70.1 HU) vs. No coronary inflammation (pFAI ≤ -70.1 HU) was evaluated on Major adverse cardiovascular events (MACEs) including cardiac death, non-fatal myocardial infarction, rehospitalization for heart failure or unstable angina, and late revascularization (HR 2.33, p=<0.001). Among patients with plaque-positive non-obstructive CAD, coronary inflammation (pFAI > -70.1 HU) was independently associated with an increased risk of long-term MACEs (HR 2.33; P<0.001).
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