Pericoronary Adipose Tissue Attenuation in Patients with Future Acute Coronary Syndromes: The ICONIC Study

Kwan AC, Tzolos E, Klein E, Han D, Lin A, Kuronuma K, Chen B, Tomasino GF, Gransar H, Slomka PJ, Cheng S, Gebhard C, Kaufmann P, Bax JJ, Cademartiri F, Chinnaiyan K, Chow BJ, Conte E, Cury RC, Feuchtner G, Hadamitzky M, Kim YJ, Leipsic JA, Maffei E, Marques H, Plank F, Pontone G, Villines TC, Al-Mallah MH, Gonçalves PdA, Danad I, Lu Y, Lee JH, Lee SE, Baskaran L, Al’aref SJ, Budoff MJ, Samady H, Stone PH, Virmani R, Achenbach S, Narula J, Chang HJ, Shaw LJ, Berman DS, Lin F, Dey D (2025)

Publication Type: Journal article

Publication year: 2025

Journal

Book Volume: 7

Article Number: e240200

Journal Issue: 3

DOI: 10.1148/ryct.240200

Abstract

Purpose: Pericoronary adipose tissue attenuation (PCATa) measured at coronary CT angiography (CCTA) is an imaging biomarker of coronary inflammation associated with long-term adverse cardiac events. The authors hypothesized that PCATa may independently identify patients at risk for acute coronary syndromes (ACS). Materials and Methods: The authors performed a retrospective substudy of the Incident Coronary Syndromes Identified by Computed Tomography (ICONIC) study, a propensity-matched case-control study of patients with CCTA followed by ACS. Two hundred analyzable case and control pairs were identified from the original 234 pairs. PCATa was measured using the adjusted attenuation of fat around proximal coronary vessels. The primary analysis applied conditional Cox models with cluster-robust standard errors to predict patient-level incident ACS, with adjustment for quantitative plaque volumes and clinical reporting–oriented findings of maximal stenosis and high-risk plaque features (HRPF). Results: A total of 400 patients with 1174 matched measurable vessels were included. PCATa was not significantly different between patients with future ACS versus controls (−72.99 HU ± 9.42 vs −73.96 HU ± 9.47; P =.08). Conversely, PCATa was significantly associated with incident ACS events in Cox models (adjusted for noncalcified plaque hazard ratio [HR]: 1.015; 95% CI: 1.001, 1.028; P =.03; adjusted for total plaque HR: 1.015; 95% CI: 1.002, 1.029; P =.03; adjusted for stenosis and HRPF HR: 1.014; 95% CI: 1.000, 1.028; P =.049). Conclusion: Limited quantitative difference in PCATa between patients and controls matched for risk factors and coronary artery disease suggests that PCATa may not be a useful single marker to identify future ACS. Nonetheless, significant differences seen in adjusted survival models identify a small biologic effect for increased risk of future ACS independent of traditional risk factors.

Authors with CRIS profile

Involved external institutions

Medizinische Universität Innsbruck Austria (AT) Technische Universität München (TUM) Germany (DE) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR) University of British Columbia Canada (CA) Cedars-Sinai Medical Center United States (USA) (US) SDN Istituto di Ricerca Diagnostica e Nucleare Italy (IT) Hospital da Luz Portugal (PT) Beaumont Health United States (USA) (US) Walter Reed National Military Medical Center United States (USA) (US) University of Ottawa Canada (CA) Houston Methodist United States (USA) (US) Università degli studi di Milano Italy (IT) Baptist Health South Florida United States (USA) (US) Amsterdam University Medical Centers (Amsterdam UMC) / Amsterdam Universitair Medische Centra Netherlands (NL) New York Presbyterian Hospital United States (USA) (US) Hanyang University / 한양대학교 Korea, Republic of (KR) Ewha Womans University Seoul Hospital / 이대서울병원 (ko), 이화여자대학교 서울병원 Korea, Republic of (KR) National Heart Centre Singapore Singapore (SG) University of Arkansas for Medical Sciences (UAMS) United States (USA) (US) The Lundquist Institute for Biomedical Innovation United States (USA) (US) Emory University United States (USA) (US) Harvard University United States (USA) (US) CVPath Institute United States (USA) (US) Icahn School of Medicine at Mount Sinai United States (USA) (US) Severance Hospital / 세브란스 병원 Korea, Republic of (KR) University of Zurich / Universität Zürich (UZH) Switzerland (CH) Leiden University Medical Center Netherlands (NL) Consiglio Nazionale delle Ricerche (CNR) / National Research Council of Italy Italy (IT)

How to cite

APA:

Kwan, A.C., Tzolos, E., Klein, E., Han, D., Lin, A., Kuronuma, K.,... Dey, D. (2025). Pericoronary Adipose Tissue Attenuation in Patients with Future Acute Coronary Syndromes: The ICONIC Study. Radiology: Cardiothoracic Imaging, 7(3). https://doi.org/10.1148/ryct.240200

MLA:

Kwan, Alan C., et al. "Pericoronary Adipose Tissue Attenuation in Patients with Future Acute Coronary Syndromes: The ICONIC Study." Radiology: Cardiothoracic Imaging 7.3 (2025).

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