Prognostic Analysis Of Peripheral Adipose Tissue CT Attenuation Index In Patients With High-Risk Plaque Coronary Heart Disease

Objective:1.To preliminarily investigate the difference in the Fat attenuation index(FAI)values in the Left anterior descending branch(LAD)、Left circumflex coronary artery(LCx)and right coronary artery(RCA)in patients with Coronary atherosclerotic heart disease(CAD)with or without high-risk plaque.2.To explore the predictive value of FAI in patients with high-risk plaques for Major adverse cardiac events(MACE),and to provide evidence for clinical decision-making.Methods:1.In this study,according to the screening criteria,subjects were retrospectively selected to be admitted to the cardiovascular Department of our hospital from September 2020 to December 2022,and invasive coronary angiography(ICA)was performed.Patients diagnosed with CAD through the examination results were completed CCTA examination for each patient.Each patient had at least one plaque according to CCTA interpretation.General data were collected,including basic characteristics,laboratory indicators,and important risk factors.Basic characteristics include the age and sex of the patient;Important risk factors are high blood pressure,diabetes,high blood lipids,smoking and a history of alcohol abuse.CCTA results were analyzed to identify and confirm plaque segments and plaque characteristics,and FAI values of three coronary arteries were obtained.2.Binary Logistic regression of single and multiple risk factors was used to analyze the relationship between each risk factor and the occurrence of MACE in CAD patients with high-risk plaques.Univariate analysis was conducted first,and risk factors with P≤0.2 were included in subsequent multivariate analysis.In a multivariate analysis,independent predictors of MACE in CAD patients with high-risk plaques were identified.3.Receiver operating characteristic curve(ROC)was drawn to evaluate the diagnostic ability of FAI value on MACE in CAD patients with high-risk plaques.The larger area under curve(AUC),the stronger the diagnostic ability,and the corresponding cutoff value was determined.4.Survival analysis groups the patients according to the cutoff value of the FAI group with the best diagnostic ability.Those higher than or equal to the cutoff value are classified as high group,and those lower than the cutoff value are classified as low group.Kaplan-Meier survival curve was used to compare the occurrence of MACE between the two groups during follow-up.Results:1.A total of 184 patients were followed up in this study,of which 132 were successfully followed up,including 54 CAD patients with high-risk plaques(40.9%)and 78 CAD patients without high-risk plaques(59.1%).Among the 54 CAD patients with high-risk plaques,23 patients(42.6%)developed MACE.There were 31 cases(57.4%)without MACE.2.In univariate Logistic regression analysis,it was found that the history of hypertension,smoking history,LAD-FAI value,LCx-FAI value and RCA-FAI value were independent predictors of the occurrence of MACE in patients with high-risk plaques.Further multivariate Logistic regression analysis corrected for age,gender,diabetes history,hyperlipidemia and other factors,and found that LAD-FAI value and RCA-FAI value were effective risk predictors of MACE in patients with high-risk plaques.3.To compare the prediction efficiency of LAD-FAI value and RCA-FAI value,ROC curve shows that RCA-FAI has a maximum AUC of 0.921,cutoff value of-71.55 HU,sensitivity of 82.6%,specificity of 93.5%.4.Kaplan-Meier survival curves were compared between the high(RCA-FAI ≥-71.55HU)and low groups(RCA-FAI <-71.55HU)during follow-up,and there was a significant difference between the two groups,with the high group more significantly presenting with severe MACE.Conclusions:1.Compared with CAD patients without high-risk plaques,FAI values of the three coronary arteries were significantly different.2.FAI of LAD and RCA in the three coronary arteries were significantly associated with the occurrence of MACE in CAD patients with high-risk plaques,indicating that LAD-FAI and RCA-FAI in the MACE group were significantly higher than those in the non-MACE group.3.LAD-FAI and RCA-FAI,which were significantly associated with MACE occurrence in CAD patients with high-risk plaques,showed that RCA-FAI was the best independent risk predictor for MACE occurrence in CAD patients with high-risk plaques,and the optimal predictive threshold was-71.55 HU.