A new systematic review and meta-analysis in the JACC: Cardiovascular Imaging has found that higher pericoronary adipose tissue (PCAT) reduction on coronary CT angiography is linked to increased risk of major adverse cardiac events (MACE) and high-risk plaque (HRP), despite variability in measurement techniques.

Researchers reviewed 17 studies, including 10,482 participants, with quantitative meta-analysis performed on 8,396 patients. Elevated right coronary artery (RCA) PCAT attenuation was significantly associated with MACE (HR: 1.22). Associations were weaker for the left circumflex artery (HR: 1.03) and non-significant for the left anterior descending artery (HR: 1.01).

No pooled analysis could be performed for HRP. Qualitative synthesis of available studies revealed a positive association between elevated RCA-PCAT attenuation and HRP, with hazard ratios ranging from 1.03 to 5.62.

The relationship persisted regardless of whether PCAT was measured using mean attenuation or fat attenuation index, and across studies with slightly different cutoffs for defining elevated attenuation.