A multicenter retrospective study published in Cardiovascular Diabetology highlights how advanced imaging of pericoronary adipose tissue (PCAT) could reshape risk prediction in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI).

Despite advances in stent technology and optimized therapy, a significant portion of ACS patients still face major adverse cardiovascular events (MACE) after PCI. Traditional scores like ACEF and SYNTAX account for clinical and anatomical factors, but often overlook biological heterogeneity. Researchers investigated whether radiomic analysis of PCAT, derived from coronary CT angiography (CCTA), could offer a more refined approach.

The study involved 777 ACS patients across three hospitals, which had integrated PCAT radiomic scores with established clinical tools. Around 22.8% of patients experienced MACE in a median follow-up period of 5.5 years. Models including PCAT radiomics significantly improved prediction performance compared with standard risk models. These findings were confirmed by independent validation across external cohorts.

PCAT radiomics captures subtle changes in perivascular fat linked to inflammation, fibrosis, and microvascular remodeling. These factors are strongly tied to residual cardiovascular risk. By quantifying these micro-level alterations, researchers demonstrated a more personalized stratification of high-risk patients who may benefit from closer follow-up or intensified anti-inflammatory therapy.

It can be concluded that while further prospective validation is needed, PCAT radiomics can be a promising non-invasive biomarker for individualized secondary prevention in ACS. If confirmed, this approach could refine clinical decisions, optimize resource use, and improve long-term outcomes for vulnerable patients.