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Correlation Between Fat Attenuation Index and Major Adverse Cardiovascular Events: A Systematic Review and
Yingzi Tan1,2, Yaojian Wang2, Boya Zhao2
1Graduate School, Beijing University of Chinese Medicine, 100029 Beijing, China.
Insights
This meta-analysis confirms a significant link between the fat attenuation index (FAI) and major adverse cardiovascular events (MACE). Elevated FAI levels indicate a higher risk of MACE, suggesting its potential as a predictive imaging biomarker.
Area of Science:
- Cardiovascular Imaging
- Biomarkers
- Medical Diagnostics
Background:
- Previous research on the association between the fat attenuation index (FAI) and major adverse cardiovascular events (MACE) has yielded inconsistent findings.
- The fat attenuation index (FAI) is an imaging parameter derived from CT scans, reflecting lipid content in atherosclerotic plaques.
Purpose of the Study:
- To systematically evaluate the association between the fat attenuation index (FAI) and the incidence of major adverse cardiovascular events (MACE) through a meta-analysis.
- To synthesize existing evidence to clarify the predictive value of FAI for MACE risk.
Main Methods:
- A systematic literature search was conducted across four major databases (PubMed, Embase, Web of Science, Cochrane Library).
- Included studies comprised cohort, case-control, and cross-sectional designs evaluating FAI (total, RCA, LCX, LAD) and MACE.
- Data extraction and quality assessment (Newcastle-Ottawa Scale) were performed by two independent researchers. Meta-analysis was conducted using RevMan 5.4, with hazard ratios (HRs) used for risk estimation and Egger's test for publication bias assessment.
Main Results:
- Twenty-two studies with 10,224 participants were included in the meta-analysis.
- A significant correlation was found between MACE and total FAI, both as a categorical (HR=2.77) and continuous variable (HR=1.15).
- Significant associations were also observed between MACE risk and FAI in the RCA (categorical HR=2.10, continuous HR=1.06), LAD (categorical HR=2.76, continuous HR=1.09), and LCX (categorical HR=2.68, continuous HR=1.07) arteries. Individuals with higher FAI levels demonstrated a substantially increased risk of MACE.
Conclusions:
- This meta-analysis demonstrates a significant association between the fat attenuation index (FAI) and major adverse cardiovascular events (MACE).
- Elevated FAI values are consistently linked to a higher risk of experiencing MACE.
- The findings suggest that FAI holds potential as a valuable imaging biomarker for predicting MACE risk.
Background:
Numerous previous studies have examined the relationship between the fat attenuation index (FAI) and major adverse cardiovascular events (MACE), reporting inconsistent findings.
Methods:
We conducted a systematic search of four databases (PubMed, Embase, Web of Science, and the Cochrane Library) for cohort, case-control, and cross-sectional studies evaluating the association between FAI and MACE incidence. The outcomes were defined as the correlations between MACE and FAI, including total FAI, FAI of the right coronary artery (RCA), FAI of the left circumflex coronary artery (LCX), and FAI of the left anterior descending (LAD) artery. FAI was analyzed both as a continuous and categorical indicator. Two researchers determined the final inclusion of the literature based on the inclusion and exclusion criteria and completed the data extraction. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). RevMan 5.4 was used to conduct heterogeneity tests, perform statistical pooling, and generate forest plots. Hazard ratios (HRs) were used to estimate the association between FAI and MACE risk. STATA16.0 (StataCorp LLC, College Station, TX, USA) was used to generate funnel plots, and the Egger test was applied to evaluate publication bias.
Results:
A total of 22 studies involving 10,224 participants were included: 17 cohort studies, 1 cross-sectional study, and 4 case-control studies. The meta-analysis results suggested that there was a significant correlation between MACE and total FAI (FAI as a categorical variable: HR = 2.77, 95% confidence interval (CI) = 2.22-3.46; p < 0.00001; FAI as a continuous variable: HR = 1.15, 95% CI = 1.05-1.26; p = 0.003). There was also a significant association between MACE risk and FAI for the RCA (FAI as a categorical variable: HR = 2.10, 95% CI = 1.58-2.79; p < 0.00001; FAI as a continuous variable: HR = 1.06, 95% CI = 1.04-1.08; p < 0.00001), a significant correlation between the risk of MACE and FAI for the LAD (FAI as a categorical variable: HR = 2.76, 95% CI = 1.93-3.97; p < 0.00001; FAI as a continuous variable: HR = 1.09, 95% CI = 1.06-1.11; p < 0.00001), a significant correlation between the risk of MACE and FAI for the LCX branch (FAI as a categorical variable: HR = 2.68, 95% CI = 1.24-5.80; p = 0.01; FAI as a continuous variable: HR = 1.07, 95% CI = 1.05-1.10; p < 0.00001). Meanwhile, individuals with elevated FAI levels had a significantly increased risk of developing MACE.
Conclusion:
The results of this meta-analysis show a significant association between FAI and MACE. Higher FAI values are associated with significantly higher risks of MACE. These results suggest that FAI may serve as an imaging indicator for predicting the risk of MACE.
Prospero Registration:
CRD420250652674, https://www.crd.york.ac.uk/PROSPERO/view/CRD420250652674.
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