High perivascular fat attenuation index at proximal segment right coronary artery may predict MACE: Study
Researchers have found in a new study that high perivascular fat attenuation index (FAI) at the proximal segment of the right coronary artery (RCA) is strongly associated with an increased risk of long-term major adverse cardiovascular events (MACE). It may serve as a valuable tool for cardiovascular risk stratification in young individuals suspected of coronary artery disease (CAD). This study was conducted by Yani Yu and fellow researchers published in the journal BMC Cardiovascular Disorders.
The perivascular FAI, assessed using coronary computed tomographic angiography (CCTA), has been established as a prognostic marker for cardiovascular risk. However, limited research has focused on its predictive value in younger populations. This study aimed to evaluate the association between FAI and long-term MACE risk in individuals aged 45 years or younger who underwent CCTA due to suspected CAD.
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
