Non-invasive characterization of pancoronary inflammation by computed tomography angiography in patients with recent spontaneous coronary dissection

Abstract Background Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic cause of myocardial infarction unclear aethiology. Histopathological analyses have identified increased inflammation in patients with SCAD [1]. Recently the peri-coronary adipose tissue attenuation (PCAT) derived from standard computed tomography angiography (CTA) has been established as reproducible method for measuring vascular which enhances risk stratification atherosclerosis [2]. Purpose To characterize pancoronary and vessel-specific by means CTA-derived PCAT recent compared individuals without prior SCAD. Methods Patients confirmed referred to tertiary center between 2017 2021 who underwent CTA routine cardiac evaluation were included this retrospective study. Subjects matched 1:1 no within same timespan, using scanner imaging protocol, arteries free obstructive disease similar clinical characteristics (Table 1). was analyzed on end-diastolic reconstructions semi-automated software methodology (Figure 1A) [3]. Proximal 40 mm all major vessels >2 diameter well SCAD-related vessel included. The primary outcome defined mean right (RCA), left anterior descending (LAD) circumflex (LCX) artery. Secondary RCA averaged LAD LCX (PCAT LCA). Results final cohort comprised 35 (median 6.1 mo. [4.0–16.8] since SCAD, 94.3% female) non-SCAD group. Pancoronary higher group (−80.1 [IQR: −74.5, −84.6] vs. −83.4 HU [−78.7, −88.0], P=0.008) suggestive inflammation. Vessel-specific (−80.7 [−70.4, −86.9] −85.3 [−80.4, −90.6] HU, P<0.001) borderline LCA (−79.2 [−73.9, −83.2] [−78.0, −88.3] P=0.056) respectively 1B). In previously dissected not significantly different unaffected (−78.4 [−73.7, −89.0] −80.9 [−74.9, −83.3], P=0.77; Figure 1C). While numerically decreased time association statistically significant when stratified into tertiles according 1D). Conclusions pericoronary suggesting perivascular inflammatory activity. This restricted vessel, nor reflected serum analysis persists over time. Funding Acknowledgement Type funding sources: None.