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Background <p>The pericoronary fat attenuation index (pFAI), derived from coronary computed tomography angiography (CCTA), is an emerging marker of local inflammation of coronary arteries. Its prognostic significance in patients with coronary artery disease (CAD) and chronic kidney disease (CKD), which share common inflammatory pathways, remains uncertain. This study aimed to assess the associations between the pFAI and cardiovascular and mortality risk in patients with concurrent CAD and CKD.</p> Methods <p>Patients with both CAD and CKD who underwent CCTA within 1 year of invasive coronary angiography were included from Cardiorenal Improvement-Ⅱ. The pFAI was measured around the proximal 40&#xa0;mm of the left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). High pFAI values were determined from the median levels of LAD (-81.0 HU), LCX (-78.8 HU) and RCA (-79.4 HU). The primary outcome was major adverse cardiovascular events (MACEs), including cardiovascular mortality, nonfatal myocardial infarction and stroke, and the secondary outcomes were cardiovascular and all-cause mortality. Multivariate Cox proportional hazards regression analysis was used to investigate the associations between pFAI and MACEs and cardiovascular and all-cause mortality.</p> Results <p>A total of 444 patients (mean age 70.7 ± 9.6 years, 32% female) were included, and 90 (20.3%) cases of MACE, 68 (15.3%) cases of cardiovascular mortality, and 125 (28.2%) cases of all-cause mortality occurred, with a median follow-up of 4.57 years. For MACEs in patients with high pFAI levels compared with those with low pFAI levels, the multivariable adjusted HR was 1.65 (95% CI: 1.02–2.66; <i>P</i> = 0.042) for LAD, 2.06 (95% CI: 1.23–3.45; <i>P</i> = 0.006) for LCX, and 1.71 (95% CI: 1.07–2.74; <i>P</i> = 0.025) for RCA. For cardiovascular and all-cause mortality, similar significant associations were observed (all <i>P</i> &lt; 0.05).</p> Conclusions <p>A high pFAI for each major coronary artery was independently associated with an increased risk of MACEs and cardiovascular and all-cause mortality in patients with CAD and CKD.</p> Graphical Abstract <p></p>

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Pericoronary fat attenuation index on coronary CT angiography and cardiovascular risk in patients with coronary artery disease and chronic kidney disease

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月12日

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  • Xiaozhao Lu,
  • Pan Wei,
  • Shangyi Tang,
  • Weitao Ye,
  • Zuxian Huang,
  • Ziyao Yuan,
  • Huangtao Ruan,
  • Haozhang Huang,
  • Weipeng Zhang,
  • Chenyang Wang,
  • Yu Kang,
  • Jing Hu,
  • Zeliang Li,
  • Jingru Deng,
  • Yingying Li,
  • Wanying Wu,
  • Wai-kit Ming,
  • Chun-Ka Wong,
  • Ning Tan,
  • Shiqun Chen,
  • Jin Liu,
  • Jiyan Chen,
  • Yong Liu

摘要

Background

The pericoronary fat attenuation index (pFAI), derived from coronary computed tomography angiography (CCTA), is an emerging marker of local inflammation of coronary arteries. Its prognostic significance in patients with coronary artery disease (CAD) and chronic kidney disease (CKD), which share common inflammatory pathways, remains uncertain. This study aimed to assess the associations between the pFAI and cardiovascular and mortality risk in patients with concurrent CAD and CKD.

Methods

Patients with both CAD and CKD who underwent CCTA within 1 year of invasive coronary angiography were included from Cardiorenal Improvement-Ⅱ. The pFAI was measured around the proximal 40 mm of the left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). High pFAI values were determined from the median levels of LAD (-81.0 HU), LCX (-78.8 HU) and RCA (-79.4 HU). The primary outcome was major adverse cardiovascular events (MACEs), including cardiovascular mortality, nonfatal myocardial infarction and stroke, and the secondary outcomes were cardiovascular and all-cause mortality. Multivariate Cox proportional hazards regression analysis was used to investigate the associations between pFAI and MACEs and cardiovascular and all-cause mortality.

Results

A total of 444 patients (mean age 70.7 ± 9.6 years, 32% female) were included, and 90 (20.3%) cases of MACE, 68 (15.3%) cases of cardiovascular mortality, and 125 (28.2%) cases of all-cause mortality occurred, with a median follow-up of 4.57 years. For MACEs in patients with high pFAI levels compared with those with low pFAI levels, the multivariable adjusted HR was 1.65 (95% CI: 1.02–2.66; P = 0.042) for LAD, 2.06 (95% CI: 1.23–3.45; P = 0.006) for LCX, and 1.71 (95% CI: 1.07–2.74; P = 0.025) for RCA. For cardiovascular and all-cause mortality, similar significant associations were observed (all P < 0.05).

Conclusions

A high pFAI for each major coronary artery was independently associated with an increased risk of MACEs and cardiovascular and all-cause mortality in patients with CAD and CKD.

Graphical Abstract