Clin Radiol. 2026 Mar 12;97:107310. doi: 10.1016/j.crad.2026.107310. Online ahead of print.
ABSTRACT
AIM: The aim of this comprehensive updated systematic review and meta-analysis was to evaluate the prognostic value of the pericoronary fat attenuation index (FAI) for major adverse cardiovascular events (MACEs) and its ability to differentiate vulnerable from stable plaques.
MATERIALS AND METHODS: A comprehensive literature search was conducted in PubMed, the Cochrane library, and Embase with the search terms 'Epicardial Adipose Tissue' and 'Tomography, X-Ray Computed' until 28 May 2025. Data were extracted and methodological quality was assessed by two independent investigators according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Fifteen studies were included in this systematic review and meta-analysis. All statistical analyses were performed using Review Manager software, version 5.3 and R 4.5.2.
RESULTS: The results indicated that higher pericoronary FAI values provided incremental prognostic value for MACE in studies with prospective follow-up (hazard ratio [HR]=3.28, 95% confidence interval [CI]: 2.03 to 5.32, P<0.001, I2 = 81%). When specifically evaluating cardiac death as an outcome, the HR increased to 4.02 (95% CI: 1.26 to 12.88, P=0.02, I2 = 92%), but this finding was not robust. Furthermore, FAI demonstrated a statistically significant elevation in vulnerable plaques compared to stable plaques, exhibiting a mean difference of 7.81 Hounsfield units (95% CI: 4.65 to 10.97, I2 = 85%). Dynamic FAI changes may help monitor therapeutic responses, but current evidence is too limited to support FAI as a surrogate endpoint for coronary anti-inflammatory interventions.
CONCLUSION: These collective findings underscore the role of pericoronary FAI as a promising indicator for detecting coronary inflammation, distinguishing vulnerable plaques, and predicting MACE.
PMID:41980471 | DOI:10.1016/j.crad.2026.107310