Pericoronary inflammation on CTA modulates lipoprotein(a) risk after PCI

In post-PCI coronary artery disease patients, pericoronary fat attenuation index (FAI) on CTA modifies Lp(a)'s MACE risk: high Lp(a)+high FAI-LAD yields HR 2.69 (95% CI 1.75–4.10) vs HR 1.10 when FAI is low. Combined AUC 0.713 vs 0.599 for conventional risk factors alone.

• Retrospective cohort of ~2,011 CAD patients post-PCI with coronary CTA obtained within 3 months pre-procedure; 181 (9.0%) experienced MACE over a median 3-year follow-up. High FAI-LAD independently predicted MACE (HR 2.06, 95% CI 1.51–2.81); high Lp(a) alone yielded HR 1.29 (95% CI 1.05–1.76).
• XGBoost model achieved AUC 0.936 with SHAP analysis ranking FAI-LAD as the top feature (SHAP value 1.57); restricted cubic splines revealed a nonlinear relationship with MACE risk escalating sharply above FAI-LAD −77 HU. Not externally or prospectively validated.
• Single-center, retrospective design in a Chinese population using a 30 mg/dL Lp(a) cut-off per Chinese lipid guidelines — external validity to other ethnic groups and health systems with differing Lp(a) thresholds (e.g., ≥50 mg/dL per ESC) is uncertain.

RadPigeon summaries are original and for information only. They are not clinical advice.