Key result
High local and systemic inflammation linked to ~4.2-fold higher post-PCI vessel-oriented composite events.
Why the study?
Although inflammation influences outcomes after PCI, the relative impact of local coronary inflammation versus systemic inflammation on vessel-oriented outcomes in patients with CAD remained unclear.
Does local coronary inflammation measured by pericoronary fat attenuation index (FAI) improve the prediction of vessel-oriented composite endpoints compared to systemic inflammation measured by hs-CRP in patients with CAD undergoing PCI?
Cohort (n=2,075)
Does local coronary inflammation measured by pericoronary fat attenuation index (FAI) improve the prediction of vessel-oriented composite endpoints compared to systemic inflammation measured by hs-CRP in patients with CAD undergoing PCI?
Answers are grounded in this paper and cite their sources.
In CAD patients undergoing PCI, local coronary inflammation assessed by CT-derived pericoronary fat attenuation index is more strongly associated with adverse vessel-oriented outcomes than systemic inflammation, and combining both markers significantly improves risk stratification.
Background Inflammation influences outcomes after percutaneous coronary intervention (PCI). However, the relative impact of local coronary inflammation versus systemic inflammation on vessel-oriented outcomes remains unclear. This study aimed to compare their prognostic value for vessel-oriented composite endpoints (VOCE) in patients with coronary artery disease (CAD) undergoing PCI. Methods In 2,075 CAD patients undergoing PCI with pre-procedural coronary CT angiography, pericoronary fat attenuation index (FAI) in major coronary vessels were quantified. Systemic inflammation was evaluated by high-sensitivity CRP (hs-CRP). Multivariable Cox analyses, restricted cubic splines, Kaplan–Meier analyses were used. Subgroup analyses were conducted. VOCE was analyzed including vessel-related cardiac death, vessel-related myocardial infarction (nonprocedural) and targeted vessel revascularization (TVR). Results Over median 3 years follow-up, 126 target vessels (4.9%) experienced VOCE. After multivariable adjustment, local inflammation (FAI-LAD, FAI-LCX, FAI-RCA, FAI-MAX, FAI-MEAN, FAI-MIN) was independently associated with VOCE. XGBoost identified FAI-MAX as the most important local predictor (SHAP value 1.44 for VOCE). Patients with combined high local (FAI-MAX ≥-70.00HU) and high systemic inflammation had the highest risk (VOCE: HR 4.23, 95% CI 2.44-7.33; both P<0.001). Notably, high local inflammation with low systemic inflammation conferred greater risk than low local with high systemic inflammation for VOCE (FAI-targeted for HR 1.66 vs. 1.20). Integration of FAI with hs-CRP significantly improved prognostic prediction over either marker alone (AUC 0.711 for FAI-MAX + hs-CRP vs. 0.589 for hs-CRP alone, DeLong P<0.05). Conclusion In CAD patients after PCI, local coronary inflammation (FAI-MAX and FAI-targeted) may demonstrate a stronger and more direct association with adverse outcomes than systemic inflammation. Integrating both improves risk stratification, supporting inflammation-guided management in CAD.
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Ye et al. (2026) conducted a cohort in Coronary artery disease undergoing percutaneous coronary intervention (n=2,075). Combined high local coronary inflammation (FAI-MAX ≥-70.00 HU) and high systemic inflammation (hs-CRP) vs. Low local and systemic inflammation was evaluated on Vessel-oriented composite endpoints (VOCE: vessel-related cardiac death, nonprocedural vessel-related myocardial infarction, and targeted vessel revascularization) (HR 4.23, 95% CI 2.44-7.33, p=<0.001). Combined high local coronary and systemic inflammation strongly predicted vessel-oriented composite endpoints post-PCI.
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