Combined lesion-specific pericoronary adipose tissue attenuation and triglyceride-glucose body mass index for improved risk stratification of major adverse cardiovascular events in patients with stable angina pectoris.

Background: Although patients with stable angina pectoris (SAP) are generally considered to be at lower risk than those with acute coronary syndromes (ACS), their risk of major adverse cardiovascular events (MACEs) remains substantial. Lesion-specific pericoronary adipose tissue attenuation (PCATa-lesion) reflects local coronary inflammation, and the triglyceride-glucose body mass index (TyG-BMI) is a robust surrogate of insulin resistance (IR) and metabolic dysfunction; however, their combined prognostic value remains unclear. This study aimed to evaluate whether incorporating TyG-BMI and PCATa-lesion into conventional clinical and coronary computed tomography angiography (CCTA) models improves MACEs prediction and risk stratification in SAP patients. Methods: In this retrospective study, patients with SAP who underwent CCTA from January 2017 to December 2020 were included. Clinical and imaging data were collected, including PCATa-lesion, TyG-BMI, plaque characteristics, and coronary artery calcium score (CACS). Statistical analyses included Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), time-dependent receiver operating characteristic curve, Kaplan-Meier analysis and decision curve analysis (DCA). Results: A total of 212 patients were enrolled, with 43 MACEs occurring over a median follow-up of 36 months. Multivariable Cox regression analysis identified age (HR =1.052, 95% CI: 0.999-1.108; P=0.049), degree of stenosis (DS) (HR =1.079, 95% CI: 1.047-1.112; P=0.031), TyG-BMI (HR =2.198, 95% CI: 1.091-4.426; P=0.027) and PCATa-lesion (HR =1.117, 95% CI: 1.067-1.169, P<0.001) as independent predictors of MACEs. Kaplan-Meier curve demonstrated that patients in the highest tertile of PCATa-lesion and those with elevated TyG-BMI had a significantly increased risk of MACEs (P<0.001). Higher PCATa-lesion values were also significantly associated with increased incidence of high-risk plaques (HRP) (P=0.014). Subgroup analysis revealed a significant difference in PCATa-lesion between SAP patients with and without comorbid diabetes mellitus (DM) (P=0.016); importantly, elevated PCATa-lesion levels were associated with a substantially higher risk of adverse events in DM patients compared to non-DM individuals. Furthermore, the integrated model incorporating PCATa-lesion and TyG-BMI demonstrated superior goodness-of-fit, discriminatory ability, and net clinical benefit across a range of risk thresholds compared to the conventional model (age and DS only). Conclusions: PCATa-lesion is an independent prognostic factor for MACEs in patients with SAP. The combination of PCATa-lesion and TyG-BMI provides incremental predictive value for assessing MACEs risk in SAP patients.