In ACS patients, high visceral obesity (BRI≥4.5) increased MACCE risk by 31% and combining BRI with high plaque inflammation (FAI≥-70.1HU) nearly doubled this risk (HR=1.97).
Does the combination of visceral obesity (assessed by BRI) and coronary plaque inflammation (assessed by FAI) predict long-term cardiovascular outcomes in patients with acute coronary syndrome?
Integrating visceral obesity metrics and CCTA-derived coronary plaque inflammation significantly enhances precision risk stratification for long-term cardiovascular events in patients with acute coronary syndrome.
Abstract Background Both visceral obesity and inflammation were associated with the progression of acute coronary syndrome (ACS). However, the combined prognostic impact of visceral obesity and coronary inflammation in ACS patients remains unclear. Objectives This study sought to evaluate the association between visceral obesity and long-term cardiovascular outcomes in ACS patients stratified by coronary inflammation status. Methods The current study was a post-hoc analysis of OSA-ACS project (NCT03362385). Visceral obesity was assessed using BRI (cutoff≥4.5, determined by Kaplan–Meier curve and restrictive cubic spline curve), a novel visceral adiposity index, while plaque inflammation was quantified by fat attenuation index (FAI; FAI≥-70.1HU defined high inflammation) using coronary computed tomography angiography (CCTA). The primary endpoint was major adverse cardiovascular and cerebrovascular event (MACCE), including cardiovascular death, myocardial infarction (MI), stroke, ischemia-driven revascularization or hospitalization for unstable angina (UA) or heart failure. Results A total of 1734 ACS patients (85.1% male, mean age 55.0 ± 10.2 years) were included in the final analysis. During a median follow-up of 2.9 years (1.5–3.6) follow-up, high BRI was associated with a higher incidence of MACCE (53.9% vs 46.1%; adjusted hazard ratio(HR)=1.31; 95% CI: 1.06 - 1.61; P=0.01). Synergistic risk stratification was observed when combining BRI with coronary inflammation. Patients with low BRI combined with high FAIexhibited the highest MACCE risk (adjusted HR=1.97, 95% CI: 1.12-3.46, P=0.019). Patients in non-criminal vessel with low BRI combined with high FAI also exhibited the highest MACCE risk (adjusted HR=2.29, 95% CI: 1.20-4.39, P=0.012). Conculsion BRI was independently associated with an increased risk of subsequent events. Integrating plaque inflammation significantly enhanced risk prediction. These findings highlight the clinical utility of combining BRI and coronary inflammation for precision risk stratification in ACS populations.figure
Zhang et al. (2025) studied this question. In ACS patients, high visceral obesity (BRI≥4.5) increased MACCE risk by 31% and combining BRI with high plaque inflammation (FAI≥-70.1HU) nearly doubled this risk (HR=1.97).
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