Predicting Periprocedural Myocardial Infarction in Chronic Coronary Syndrome Using CT-derived Fat Attenuation Index and Triglyceride Glucose–Body Mass Index

Purpose To evaluate whether pre-percutaneous coronary intervention (PCI) pericoronary fat attenuation index (FAI) and triglyceride glucose-body mass index (TyG-BMI) predicted periprocedural myocardial infarction (PMI) and major adverse cardiovascular events (MACEs) in participants with chronic coronary syndrome (CCS). Materials and Methods In this prospective, single-center observational study (Chinese Clinical Trial Registry: ChiCTR2200059723) conducted from May 2022 to March 2025, 476 participants with CCS undergoing coronary CT angiography (CCTA) within 90 days before elective PCI were enrolled. FAI was measured on CCTA images, and TyG-BMI was calculated from laboratory tests. PMI was defined as an increase in high-sensitivity cardiac troponin T level to more than five times the upper limit of normal after PCI. MACEs include cardiovascular death, spontaneous myocardial infarction, in-stent restenosis, and target vessel revascularization. Receiver operating characteristic curve analysis (AUC, DeLong method) assessed associations and model discrimination. Kaplan-Meier and log-rank tests compared event-free survival. Two-sided <i>P</i> values less than .05 indicated significance. Results Among 476 participants (median age, 63 years [IQR, 56-68 years]; 147 female, 329 male), PMI occurred in 114 participants (23.9%). Median TyG-BMI was higher in the PMI group than in non-PMI group (239.7 [IQR, 215.5-270.9] vs 224.8 [IQR, 202.6-249.8]; <i>P</i> < .001); median FAI score was less negative (-73.5 HU [IQR, -83.3 to -68.0 HU] vs -81.0 HU [IQR, -87.3, -74.0 HU]; <i>P</i> < .001). A model combining FAI and TyG-BMI with clinical variables achieved an AUC of 0.72 (95% CI: 0.67, 0.78) versus an AUC of 0.67 (95% CI: 0.62, 0.73) for clinical variables alone (<i>P</i> = .002). Over a median 24-month follow-up, participants with both high TyG-BMI and FAI greater than -70.1 HU exhibited the highest MACE rate (overall comparison, <i>P</i> < .001). Conclusion Preoperative FAI and TyG-BMI were independently associated with PMI and MACEs in participants with CCS undergoing PCI. <b>Keywords:</b> CT-Coronary Angiography, Stents, Coronary Arteries, Fat Attenuation Index, Triglyceride Glucose-Body Mass Index, Periprocedural Myocardial Infarction, Major Adverse Cardiovascular Events, Percutaneous Coronary Intervention Chinese Clinical Trial Registry: ChiCTR2200059723 <i>Supplemental material is available for this article.</i> © The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license.