Key result
Higher pericoronary adipose tissue attenuation on CCTA independently predicts cardiac events beyond plaque and hsCRP.
Why the study?
Systemic inflammatory markers like hsCRP have proven neither sufficient nor necessary to select patients who benefit from targeted anti-inflammatory therapies for atherosclerotic cardiovascular disease. Whether pericoronary adipose tissue (PCAT) attenuation, a coronary-specific measure of inflammation, translates into better patient selection remains to be shown.
Pericoronary adipose tissue (PCAT) attenuation measured on routine CCTA offers a promising coronary-specific marker of inflammation to predict cardiac events and potentially guide targeted anti-inflammatory therapy, though randomized validation is still needed.
Answers are grounded in this paper and cite their sources.
PCAT attenuation on CCTA may refine event prediction beyond hsCRP; leaves open its utility for guiding anti-inflammatory therapy pending randomized validation.
PURPOSE OF REVIEW: Inflammation drives atherosclerotic cardiovascular disease, yet targeted therapies remain scarce, and identifying which patients benefit has been a central challenge. High-sensitivity C-reactive protein (hsCRP), a systemic marker, has been used to select patients for anti-inflammatory trials but has proven neither sufficient nor necessary: the Ziltivekimab Cardiovascular Outcomes Trial (ZEUS), a recent phase 3 trial of an anti-interleukin-6 agent, lowered hsCRP yet did not reduce events, whereas colchicine reduced cardiovascular events in COLCOT and LoDoCo2 without hsCRP-based selection. Pericoronary adipose tissue (PCAT) attenuation offers a novel, coronary-specific measure of inflammation; whether it translates into better patient selection for anti-inflammatory therapy remains to be shown. RECENT FINDINGS: Measured from routine coronary CT angiography (CCTA), PCAT attenuation reflects inflammation within the coronary wall and, in large observational cohorts, predicts cardiac events independent of plaque burden, traditional risk factors, and hsCRP. Early interventional studies suggest it may also serve as a dynamic endpoint, though this evidence remains preliminary. SUMMARY: PCAT attenuation could enable precision anti-inflammatory prevention - selecting patients by coronary inflammatory risk rather than nonspecific systemic markers, and serving as a pharmacodynamic endpoint in mechanistic trials. Key gaps remain: randomized evidence that PCAT-guided care improves outcomes, treatment thresholds, longitudinal stability, reproducibility, and contrast-free validation.
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Avivi et al. (2026) conducted a review in Atherosclerotic cardiovascular disease. Pericoronary adipose tissue (PCAT) attenuation on coronary CT angiography vs. High-sensitivity C-reactive protein (hsCRP) was evaluated on Cardiac events. Pericoronary adipose tissue attenuation on CCTA predicts cardiac events independent of plaque burden and hsCRP, potentially enabling precision anti-inflammatory selection.
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