High perivascular fat attenuation index at proximal segment right coronary artery may predict MACE: Study

Perivascular FAI at the proximal RCA in 503 adult patients aged ≤45 years at baseline who received CCTA in 2015-2016 and were at least five-year follow-up performed was measured; they were split into high or low FAI groups based on an optimal cutoff value of −75.2 HU. Cox hazard regression and Kaplan-Meier (K-M) survival analysis were performed to assess the prognostic value of FAI and its improvement over traditional risk factor prediction models.

Results

• Patients with high FAI (≥-75.2 HU) had a significantly lower event-free survival rate at a median follow-up of 72.7 months than those with low FAI (<-75.2 HU) (93.9% vs. 99.7%, p< 0.001).

• High FAI was significantly related to an increased risk of MACE (HR = 19.257, 95% CI: 2.504-148.107, p= 0.004).

• Adding FAI to traditional risk factor models resulted in improved predictability, which increased the area under the curve from 0.728 to 0.845 (p< 0.001).

• It also indicated improvements in the integrated discrimination index (p=0.033). Additionally, it improved the net reclassification index, NRI = 0.597, 95% CI: 0.000-0.699 (p=0.024).

The study authors concluded that high perivascular FAI at the proximal RCA is a robust predictor of long-term MACE in young adults. This study's outcomes need further verification and exploration on the possibility of incorporating FAI assessment into routine clinical practice.

Reference:

Yu, Y., Shan, D., Wang, X. et al. Predictive value of the perivascular fat attenuation index for MACE in young people suspected of CAD. BMC Cardiovasc Disord 25, 80 (2025). https://doi.org/10.1186/s12872-024-04401-0