Pericoronary adipose tissue radiomics to improve risk stratification for patients with acute coronary syndrome: a multicenter retrospective cohort study
Authors' conclusion
PCAT radiomics can enhance long-term prediction of MACE in ACS patients beyond current clinical scores, traditional CCTA and PCATa. Addition of PCAT radiomics to a conventional risk assessment improves the identification of high-risk individuals with MACE.
Study context
- Population
- Patients with acute coronary syndrome undergoing pre-intervention coronary computed tomography angiography (CCTA) at 3 medical centers; 61.0 ± 9.70 years, 506 males664 internal cohort
- Participants
- 777 patients
- Exposure
- Models with pericoronary adipose tissue (PCAT) radiomics added vs models with clinical scores, traditional CCTA and PCAT attenuation
- External testn = 113
- Outcome
- MACE
- Follow-up
- Median 5.45 years (IQR 4.03, 7.12 years)
Methodological detailsmulticenter, prognostic modelling with internal and external test sets
- Multicenter
- Prognostic modelling with internal and external test sets
Main finding
As reported in the abstract
Predictive performance for MACE (C-index) after adding PCAT Radscore
| Group | C-index, PCATculprit Radscore model | C-index, three vessels-based PCAT Radscore model |
|---|---|---|
| Training set | 0.721 | 0.725 |
| Internal test set | 0.652 | 0.660 |
| External test set | 0.645 | 0.686 |
C-index, PCATculprit Radscore model
Training set0.721
Internal test set0.652
External test set0.645
C-index, three vessels-based PCAT Radscore model
Training set0.725
Internal test set0.660
External test set0.686
- Major adverse cardiovascular events (MACE) events
- 177 (22.78%)
- Adding PCAT Radscores improved model predictive performance, without significant differences between datasets or models
- all P > 0.05
Observational data: associations, not effects.
Further findings
| Outcome | Training set | External test set |
|---|---|---|
| Discrimination and reclassification: PCATculprit Radscore added to clinical model | ||
| IDI | 0.031, p < 0.001 | 0.094, p < 0.001 |
| NRI | 0.256, p < 0.001 | 0.339, p = 0.02 |
| Discrimination and reclassification: three vessels-based PCAT Radscore added to clinical model | ||
| IDI | 0.032, p < 0.001 | 0.126, p < 0.001 |
| NRI | 0.224, p = 0.02 | 0.480, p < 0.001 |
Original publication
Pericoronary adipose tissue radiomics to improve risk stratification for patients with acute coronary syndrome: a multicenter retrospective cohort study. Cardiovasc Diabetol. Published 31 August 2025. doi:10.
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