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Difference of pericoronary adipose tissue attenuation between culprit and non-culprit lesions in acute coronary syndrome: a systematic review and meta-analysis
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DOI：10.1186/s12872-026-05785-x.png)
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Abstract
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Background Pericoronary adipose tissue (PCAT) attenuation, a non-invasive marker of coronary inflammation, predicts adverse cardiovascular events. However, the extent of localized inflammation at the culprit lesion site in acute coronary syndrome (ACS) has not been systematically quantified. We aimed to meta-analyze the difference in PCAT attenuation between culprit and non-culprit lesions in patients with ACS. Methods We systematically searched PubMed and Embase for studies comparing PCAT attenuation between culprit and non-culprit lesions/vessels in ACS patients. A random-effects model was used to calculate the pooled mean difference (MD). Pre-specified subgroup and meta-regression analyses were performed to explore heterogeneity. Results Twelve studies with 826 patients were included. Meta-analysis was performed in 11 studies comprising 12 cohorts (461 culprit/731 non-culprit lesions and 388 culprit/487 non-culprit vessels). PCAT attenuation was significantly higher around culprit sites compared to non-culprit sites (MD 4.95 HU, 95% CI: 2.62-7.27, p < 0.001), with substantial heterogeneity (I & sup2;=89%). Subgroup analysis revealed a significantly greater effect size when PCAT was measured at the perilesional level (MD 7.50 HU) versus the vessel level (MD 2.43 HU). Meta-regression identified the analysis lesion unit (p = 0.002) and ACS subtype (p = 0.003) as major sources of heterogeneity. Conclusion This meta-analysis provides consistent evidence that culprit lesions in ACS are characterized by a measurable and highly localized increase in pericoronary inflammation. A perilesional measurement approach may better capture this focal inflammatory signal, highlighting the potential of PCAT attenuation for identifying culprit lesion in ACS.
Keywords:
Pericoronary adipose tissue
Acute coronary syndrome
Culprit lesion
Fat attenuation index
Inflammation
Coronary computed tomography angiography
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