Key result
Higher LAD PCAT attenuation linked to ~25% higher odds of ACS versus stable CAD.
Why the study?
The utility of CCTA-derived pericoronary adipose tissue volume and attenuation for distinguishing ACS from stable CAD in patients with angiographically verified CAD remained to be determined.
Does CCTA-derived pericoronary adipose tissue (PCAT) volume and attenuation index distinguish acute coronary syndrome from stable coronary artery disease in patients with angiography-verified coronary artery disease?
Cohort (n=180)
Blinded image analysis (physicians blinded to patient grouping, CCTA images, and PCAT measurements)
Yes
Does CCTA-derived pericoronary adipose tissue (PCAT) volume and attenuation index distinguish acute coronary syndrome from stable coronary artery disease in patients with angiography-verified coronary artery disease?
CCTA-derived pericoronary adipose tissue parameters, particularly the LAD attenuation index and a three-vessel combined model, correlate strongly with coronary stenosis severity and provide high diagnostic accuracy for non-invasively distinguishing acute coronary syndrome from stable coronary artery disease.
Answers are grounded in this paper and cite their sources.
LAD PCAT attenuation may aid CCTA differentiation of ACS from stable CAD; leaves open prospective validation before clinical adoption.
Objectives: The purpose of this paper is to determine if the volume and attenuation of CCTA-derived PCAT can be used to distinguish stable coronary artery disease (CAD) in people with verified CAD.Methods: This retrospective study enrolled 180 patients with coronary angiography (CAG)-verified CAD, including 100 SCAD and 80 ACS.We measured PCAT metrics of the left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA).Intergroup differences, correlations with stenosis severity, receiver operating characteristic (ROC) curves, and multivariate logistic regression were analyzed.Results: PCAT volume and attenuation of three coronary arteries were significantly higher in ACS patients (all P<0.001).LAD attenuation index correlated strongest with stenosis (r=0.72,P<0.001), with an area under the curve (AUC) of 0.781 (cutoff: -68.5 HU).The three-vessel combined model yielded an AUC of 0.892.Adjusted regression identified LAD attenuation as an independent discriminator (odds ratio [OR]=1.255,P<0.001).Conclusion: CCTA-based PCAT parameters allow non-invasive differentiation between SCAD and ACS.LAD attenuation index serves as an independent predictor, and multi-vessel combined analysis further improves diagnostic efficiency.
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Zuo et al. (2026) conducted a cohort in Coronary artery disease (stable coronary artery disease and acute coronary syndrome) (n=180). CCTA-derived pericoronary adipose tissue (PCAT) attenuation index and volume (LAD, LCX, RCA) vs. Stable coronary artery disease (SCAD) vs Acute coronary syndrome (ACS) and invasive coronary angiography was evaluated on Differentiation between acute coronary syndrome (ACS) and stable coronary artery disease (SCAD) using LAD PCAT attenuation index (OR 1.255, p=<0.001). CCTA-derived LAD PCAT attenuation independently distinguished ACS from stable CAD (OR 1.255, P<0.001; AUC 0.781), while a three-vessel combined PCAT model improved diagnostic accuracy to an AUC of 0.892.
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