Association between pericoronary CT fat attenuation index and coronary artery spasm

Fat attenuation index (FAI) is currently used in research on coronary atherosclerotic heart disease, but there are no reports on FAI applications in coronary artery spasm (CAS). In this study, we explored the association between pericoronary FAI and CAS. Patients who had chest pain and stenosis < 50% in major coronary branches, as indicated by coronary CT angiography (CCTA) at our hospital from January 2022 to June 2023 were included. According to the diagnostic criteria for vasospastic angina published by the Japanese Circulation Society in 2013, patients confirmed to have CAS were assigned to a CAS group, while those who were not consistent with CAS and had a negative treadmill test were assigned to a control group. Pericoronary FAI and circulating inflammatory factor levels were measured at enrollment. Count data were analyzed using the χ2 test, measurement data using the t-test or nonparametric test, and CAS-related risk factors using multivariate logistic regression. There were 230 patients in the CAS group and 112 patients in the control group. The pericoronary FAI and smoking rate were significantly lower in the control group than in the CAS group (P < .05), but there were no significant differences in other data, including general clinical data, medication use, and circulating inflammatory factor levels (all P > .05). Univariate analysis exhibited that the CAS-related risk factors included smoking, diabetes, high-density lipoprotein cholesterol, and pericoronary FAI. Multivariate logistic regression indicated that smoking and FAI around the left anterior descending branch were significantly associated with CAS. Elevated pericoronary FAI is an independent risk factor for CAS. Local coronary inflammation plays a dominant role in CAS, while circulating inflammatory factor levels seem not to be associated with CAS.