Elevated pericoronary fat attenuation index (FAI) is an independent risk factor for coronary artery spasm, suggesting that local coronary inflammation plays a dominant role in CAS while circulating inflammatory factor levels seem not to be associated with CAS.
Key Findings
Results
Pericoronary FAI was significantly higher in the CAS group compared to the control group.
The study included 230 patients in the CAS group and 112 patients in the control group.
Patients were selected based on chest pain and coronary stenosis less than 50% on coronary CT angiography (CCTA) from January 2022 to June 2023.
The difference in pericoronary FAI between groups was statistically significant (P < .05).
The control group had significantly lower pericoronary FAI than the CAS group.
Results
Smoking rate was significantly lower in the control group than in the CAS group.
Smoking was identified as a statistically significant difference between groups (P < .05).
No significant differences were found in other general clinical data, medication use, or circulating inflammatory factor levels (all P > .05).
Smoking was identified as a CAS-related risk factor in univariate analysis.
Results
Univariate analysis identified smoking, diabetes, high-density lipoprotein cholesterol, and pericoronary FAI as CAS-related risk factors.
Four variables emerged from univariate analysis: smoking, diabetes, high-density lipoprotein cholesterol, and pericoronary FAI.
These factors were subsequently entered into multivariate logistic regression analysis.
Count data were analyzed using the χ2 test, measurement data using the t-test or nonparametric test.
Results
Multivariate logistic regression indicated that smoking and FAI around the left anterior descending branch were significantly and independently associated with CAS.
Of the four univariate risk factors, only smoking and FAI around the left anterior descending (LAD) branch remained significant in multivariate analysis.
Elevated pericoronary FAI was identified as an independent risk factor for CAS.
Diabetes and high-density lipoprotein cholesterol did not retain independent significance in multivariate analysis.
Results
Circulating inflammatory factor levels were not significantly different between the CAS group and the control group.
There were no significant differences in circulating inflammatory factor levels between the two groups (P > .05).
This finding suggests that systemic (circulating) inflammation is not associated with CAS.
The authors concluded that local coronary inflammation, as reflected by pericoronary FAI, plays a dominant role in CAS rather than systemic inflammation.
Background
FAI, a measure of pericoronary adipose tissue inflammation assessed by CT, had not previously been reported in the context of coronary artery spasm.
FAI is currently used in research on coronary atherosclerotic heart disease.
This study represents the first reported application of FAI in the context of CAS.
CAS diagnosis followed the diagnostic criteria for vasospastic angina published by the Japanese Circulation Society in 2013.
Control group patients were those not consistent with CAS who also had a negative treadmill test.
What This Means
This research suggests that inflammation around the coronary arteries — measured using a CT scan technique called the fat attenuation index (FAI) — is linked to coronary artery spasm (CAS), a condition where the arteries of the heart temporarily tighten, causing chest pain even without significant blockages. The study compared 230 patients diagnosed with CAS to 112 patients without CAS, all of whom had chest pain but less than 50% narrowing of their coronary arteries on CT imaging. Patients with CAS had notably higher pericoronary FAI values and higher smoking rates, while other factors like blood markers of systemic inflammation, medications, and general clinical characteristics were similar between groups.
When the researchers used statistical modeling to identify which factors were most strongly linked to CAS, they found that smoking and elevated FAI specifically around the left anterior descending coronary artery (one of the heart's main arteries) were the two independent risk factors. Importantly, circulating inflammatory markers in the blood were not different between the groups, suggesting that it is local inflammation right around the coronary arteries — not general body-wide inflammation — that appears most relevant to CAS.
This research suggests that CT-based measurement of pericoronary fat inflammation could potentially be a useful, non-invasive tool for identifying patients at risk for coronary artery spasm, which is often difficult to diagnose. It also points to local vascular inflammation as a potential mechanism underlying CAS, which could have implications for understanding and eventually treating this condition.
Yu C, Sheng Z, Li L, Zhou S, Wu Y, Li Y, et al.. (2026). Association between pericoronary CT fat attenuation index and coronary artery spasm.. Medicine. https://doi.org/10.1097/MD.0000000000050746