ArticleQuantitative imaging in medicine and surgery2026
Pericoronary fat attenuation index and major adverse cardiovascular events: a systematic review and meta-analysis.
Article in Quantitative imaging in medicine and surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Perivascular adipose tissue (PVAT) plays a significant role in the pathophysiology of atherosclerosis. Changes in its computed tomography (CT) attenuation reflect the inflammatory status of the vascular wall. The pericoronary fat attenuation index (FAI), derived from coronary computed tomography angiography (CCTA), is a non-invasive imaging biomarker that quantifies the CT attenuation of pericoronary fat to indirectly assess local inflammatory activity. This study aimed to evaluate the predictive value of CCTA-derived FAI for major adverse cardiovascular events (MACEs) through a meta-analysis. Methods: Two investigators systematically searched the PubMed and Web of Science databases from inception until 21 October 2025 for cohort studies assessing the association between FAI and MACE. Study quality was assessed using the Newcastle-Ottawa Scale (NOS), and the quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Adjusted hazard ratios (aHRs) and their 95% confidence intervals (CIs) were pooled using a random-effects model. Meta-analysis and sensitivity analyses were performed to explore sources of heterogeneity and the robustness of the results. Results: A total of 11 studies involving 10,288 patients were included. The meta-analysis showed the following: (I) categorical variable (high Conclusions: CCTA-derived FAI is a strong independent predictor of MACE. Incorporating FAI into routine CCTA assessment may improve cardiovascular risk stratification, demonstrating significant potential for clinical translation.
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