Prognostic Value of RCA Pericoronary Adipose Tissue CT-Attenuation Beyond High-Risk Plaques, Plaque Volume, and Ischemia

Pepijn A. van Diemen, Michiel J. Bom, Roel S. Driessen, Stefan P. Schumacher, Henk Everaars, Ruben W. de Winter, Peter M. van de Ven, Moti Freiman, Liran Goshen, Dennis Heijtel, Eran Langzam, James K. Min, Jonathon A. Leipsic, Pieter G. Raijmakers, Albert C. van Rossum, Ibrahim Danad, Paul Knaapen

Research output: Contribution to journalArticlepeer-review


Objectives: This study was designed to assess the prognostic value of pericoronary adipose tissue computed tomography attenuation (PCATa) beyond quantitative coronary computed tomography angiography (CCTA)–derived plaque volume and positron emission tomography (PET) determined ischemia. Background: Inflammation plays a crucial role in atherosclerosis. PCATa has been shown to assess coronary-specific inflammation and is of prognostic value in patients with suspected coronary artery disease (CAD). Methods: A total of 539 patients who underwent CCTA and [15O]H2O PET perfusion imaging because of suspected CAD were included. Imaging assessment included coronary artery calcium score (CACS), presence of obstructive CAD (≥50% stenosis) and high-risk plaques (HRPs), total plaque volume (TPV), calcified/noncalcified plaque volume (CPV/NCPV), PCATa, and myocardial ischemia. The endpoint was a composite of death and nonfatal myocardial infarction. Prognostic thresholds were determined for quantitative CCTA variables. Results: During a median follow-up of 5.0 (interquartile range: 4.7 to 5.0) years, 33 events occurred. CACS >59 Agatston units, obstructive CAD, HRPs, TPV >220 mm3, CPV >110 mm3, NCPV >85 mm3, and myocardial ischemia were associated with shorter time to the endpoint with unadjusted hazard ratios (HRs) of 4.17 (95% confidence interval [CI]: 1.80 to 9.64), 4.88 (95% CI: 1.88 to 12.65), 3.41 (95% CI: 1.72 to 6.75), 7.91 (95% CI: 3.05 to 20.49), 5.82 (95% CI: 2.40 to 14.10), 8.07 (95% CI: 3.33 to 19.55), and 4.25 (95% CI: 1.84 to 9.78), respectively (p < 0.05 for all). Right coronary artery (RCA) PCATa above scanner specific thresholds was associated with worse prognosis (unadjusted HR: 2.84; 95% CI: 1.44 to 5.63; p = 0.003), whereas left anterior descending artery and circumflex artery PCATa were not related to outcome. RCA PCATa above scanner specific thresholds retained is prognostic value adjusted for imaging variables and clinical characteristics associated with the endpoint (adjusted HR: 2.45; 95% CI: 1.23 to 4.93; p = 0.011). Conclusions: Parameters associated with atherosclerotic burden and ischemia were more strongly associated with outcome than RCA PCATa. Nonetheless, RCA PCATa was of prognostic value beyond clinical characteristics, CACS, obstructive CAD, HRPs, TPV, CPV, NCPV, and ischemia.

Original languageEnglish
Pages (from-to)1598-1610
Number of pages13
JournalJACC: Cardiovascular Imaging
Issue number8
StatePublished - Aug 2021
Externally publishedYes


  • Adipose Tissue/diagnostic imaging
  • Coronary Vessels/diagnostic imaging
  • Humans
  • Myocardial Infarction
  • Predictive Value of Tests
  • Prognosis
  • Tomography, X-Ray Computed
  • coronary artery disease
  • coronary computed tomography angiography
  • coronary inflammation
  • myocardial ischemia
  • pericoronary adipose tissue computed tomography attenuation

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging


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