Risk stratification study of non-calcified coronary plaques based on CT pericoronary adipose tissue measurement

To investigate the relationship between fat attenuation index (FAI) around non-calcified coronary plaques, noninvasive CT-derived fractional flow reserve (CT-FFR), and plaque parameters. The CT angiography images and clinical data of 395 hospitalized patients with suspected coronary heart disease (CHD) were retrospectively collected. Patients were divided into normal (n = 131), mild (n = 140), moderate (n = 78), and severe stenosis (n = 46) groups. All lesion groups had noncalcified plaques in a single coronary artery location (single-vessel disease). Plaque parameters, periplaque FAI, and CT-FFR were measured. Cases were stratified into high-risk (FAI ≥ -70.1 HU, n = 102) and low-risk (FAI < -70.1 HU, n = 293) groups. Coronary stenosis severity correlated positively with age (R²=0.277, P < 0.05), plaque short diameter (R²=0.257, P < 0.05), and FAI (R²=0.548, P < 0.05), and negatively with CT-FFR (R²=-0.387, P < 0.05). The high-risk FAI group had lower plaque CT values and CT-FFR (P < 0.05). FAI around non-calcified plaques correlates with stenosis severity and CT-FFR, offering a potential tool for risk stratification of acute coronary syndrome.