Association of Pericoronary Adipose Attenuation With Major Adverse Cardiovascular Events and High-Risk Plaque.

BACKGROUND The characterization of pericoronary adipose tissue (PCAT) attenuation may provide adjunctive prognostic information to coronary evaluation at coronary computed tomography angiography. However, heterogeneity in measurement methodologies has led to uncertainties regarding its clinical applicability. OBJECTIVES This systematic review and meta-analysis explores the impact of measurement methodology on the association between PCAT and major adverse cardiac events (MACE) and high-risk plaque (HRP). METHODS Studies linking PCAT to MACE and HRP were searched in online databases. Quantitative meta-analysis was only performed where univariable HR estimates were reported, and random effects modelling with 95% CIs are reported. Qualitative synthesis was performed where multivariable estimates were reported. RESULTS There were 17 studies (10,482 patients) included. Quantitative analysis was performed in 8,396 patients, all with stable coronary artery disease; elevated right coronary artery (RCA)-PCAT attenuation was associated with MACE (HR: 1.22 [95% CI: 1.08-1.38]; P = 0.001), with weak significance in left circumflex-PCAT (HR: 1.03 [95% CI: 1.01-1.05]; P = 0.014), and left anterior descending artery-PCAT did not meet significance (HR: 1.01 [95% CI: 0.98-1.05]; P = 0.47). No quantitative synthesis was possible for association with HRP. Qualitatively, studies have shown a positive and significant association with RCA-PCAT and HRP (HR range: 1.03-5.62). Although studies adjusted for different risk modifiers in multivariable models, a positive association was found despite different measurement methodology (mean PCAT, fat attenuation index) and minor differences in study-defined cutoffs for elevated RCA-PCAT attenuation. CONCLUSIONS Although the strength of associations varied by measurement technique, PCAT is associated with MACE and high-risk plaque.