Coronary inflammation predicts cardiovascular morbidity & mortality | Prof Luigi Fontana

The (ORFAN) study evaluated the ability of the coronary perivascular fat attenuation index (FAI) Score from coronary CT angiography (CCTA) to predict cardiovascular risk and guide management in individuals without obstructive coronary artery disease (CAD). This multicenter, longitudinal cohort study included 40,091 patients from eight UK hospitals, followed for a median of 2.7 years for major adverse cardiac events (MACE), including myocardial infarction, new onset heart failure, or cardiac death.
Key findings include:
1. Risk and Events in Non-Obstructive CAD: Patients without obstructive CAD comprised 81.1% of the cohort and accounted for 66.3% of total MACE and 63.7% of total cardiac deaths.
2. FAI Score: An increased FAI Score in all three coronary arteries significantly predicted higher risk for cardiac mortality and MACE. Specifically, the hazard ratios for cardiac mortality and MACE comparing the top to bottom quartile of FAI Scores were 29.8 and 12.6, respectively.
3. Independent Prediction: The FAI Score predicted cardiac mortality and MACE independently of traditional cardiovascular risk factors and the presence or extent of CAD.
4. AI-Risk Algorithm: The AI-Risk classification system, which integrates FAI Score with coronary plaque metrics and clinical risk factors, showed a strong association with cardiac mortality (HR 6.75 for very high risk vs low/medium risk) and MACE (HR 4.68 for very high risk vs low/medium risk). The model was well calibrated against actual events.
In conclusion, this study shows that vascular inflammation plays a crucial role in the pathogenesis of cardiovascular disease and mortality beyond traditional risk factors especially in patients without obstructive CAD.

[@Laras4261]

Grazie ❤

[@estersegalla2892]

🙏🌷

[@JMK-vo8pv]

I have been trying for 3 years to get my cardiologist to order a CCTA, with AI, on me because I have already had a NON-STEMI and I am at "high risk" for future MACE. All my cardiologist keeps saying is, "we don't offer that test; you don't need that test."