Prognostic value of pericoronary adipose tissue on electrocardiogram (ECG)-gated non-contrast computed tomography (CT) in patients with stable chest pain: insights from the PROMISE trial
Authors' conclusion
PCAT metrics, measured on ECG-gated non-contrast CT, are independently associated with adverse CAD features and MACE and provide incremental prognostic value beyond clinical risk factors and obstructive CAD.
Study context
- Population
- Patients with stable chest pain in the PROMISE CT arm, with pericoronary adipose tissue (PCAT) quantified on non-contrast, ECG-gated CT51% female, mean age 61 ± 8 years
- Participants
- 3,799 patients
- Comparison
- PCAT attenuation and body surface area-indexed PCAT volume, included simultaneously in all models, against coronary artery disease (CAD) characteristics and major adverse cardiovascular events (MACE)
Methodological detailsmixed-effects logistic regression, PROMISE CT arm
- Mixed-effects logistic regression
- PROMISE CT arm
Main finding
As reported in the abstract
PCAT attenuation and volume (descriptive)
PCAT attenuation
−81.4 ± 6.4 Hounsfield units (HU)
PCAT volume
12.9 ± 3.1 cm3/m²
Further findings
MACE among participants without coronary plaque (exploratory)
| Comparison | aHR (95% CI) | P value | |
|---|---|---|---|
| Higher PCAT attenuation · exploratory analysis | 1.21 (1.05–1.39) | P = 0.007 | |
| 0.512Adjusted hazard ratio (log scale) |
Stenosis ≥50% and high-risk plaque
- Attenuation adjusted odds ratios (per 1 Hounsfield units (HU))
- 1.02-1.03
- Volume adjusted odds ratios (per 1 cm3/m²)
- 1.42-1.47
- P
- all P ≤ 0.04
- Higher (less negative) PCAT attenuation and higher PCAT volume were independently associated
MACE (all-cause death or nonfatal myocardial infarction)
- Adjusted hazard ratios [aHR]
- 1.09-1.15
- P
- all P ≤ 0.02
- Additional adjustment for obstructive CAD
MACE discrimination beyond atherosclerotic cardiovascular disease (ASCVD) risk score, body mass index, and obstructive CAD
- Area under the curve
- 0.70-0.72
- P
- P = 0.03
Original publication
Prognostic value of pericoronary adipose tissue on ECG-gated non-contrast CT in patients with stable chest pain: insights from the PROMISE trial. Eur Heart J Cardiovasc Imaging. Published 19 August 2026. doi:10.
Summarised from the published abstract; every number is checked against it