Coronary CT angiography derived pericoronary inflammation and bespoke cardiovascular risk prediction in the lipid clinic: beyond the calcium score

Abstract Background Dyslipidaemia promotes atherosclerosis. Genetic dyslipidaemias, Familial Hypercholesterolaemia (FH) being the most common, are associated with heightened risk of coronary artery disease (CAD) and premature major adverse cardiovascular events (MACE). However, this is both heterogeneous modifiable treatment. CT imaging can identify subclinical atherosclerosis, enabling personalised stratification treatment targets. Coronary calcium scoring (CACS) current first-line in European guidelines for asymptomatic patients. calcification occurs late CAD pathogenesis CACS has low specificity young patients severe FH. angiography (CTCA) assesses non-calcific plaque high-risk (HRP) features unappreciable CACS. Additionally, pericoronary fat attenuation index (FAI) measures inflammation on routine CTCA strongest non-invasive biomarker fatal MI. Purpose To quantify compare reclassification atherosclerosis burden Lipid Clinic assessed via vs FAI analysis. Methods Analysis a prospectively maintained clinical database from May 2019 to December 2020. was reported standardised Agastston criteria compared (i) CTCA-derived Artery Disease – Reporting Data System (CAD RADS) grading anatomical stenosis, including modifier HRP features, (ii) Significance defined as two-tailed p75th percentile age sex matched controls) seen 6/27 (22%) none mild 6/28 (21%) CTCA, whom 3/7 (43%) had HRP. High all groups severity RADS score (Figure 2). The proportion high higher 0 4, not level (p=0.94). observed 16% treatment, suggesting failure. This included ranging (>400), minimal (1) (4). Conclusion re-stratifies presence high-risk, patient group identified features. provides incremental value identification at future MACE regardless grade, without evidence overt CAD. Identifying may imply Funding Acknowledgement Type funding sources: None.