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Coronary computed tomography angiography (CCTA) visualizes pericoronary adipose tissue (PCAT) attenuation, which reflects coronary artery inflammation. While PCAT attenuation has been reported to predict future coronary events, plaque phenotypes exhibiting high PCAT attenuation remains to be fully elucidated. The current study aims to characterize coronary atheroma with a greater vascular inflammation. We retrospectively analyzed culprit lesions in 69 CAD patients receiving PCI from the REASSURE-NIRS registry (NCT04864171). Culprit lesions were evaluated by both CCTA and near-infrared spectroscopy\/intravascular ultrasound (NIRS\/IVUS) imaging prior to PCI. PCAT attenuation at proximal RCA (PCAT<jats:sub>RCA<\/jats:sub>) and NIRS\/IVUS-derived plaque measures were compared in patients with PCAT<jats:sub>RCA<\/jats:sub> attenuation\u2009\u2265\u2009and\u2009&lt;\u2009-78.3 HU (median). Lesions with PCAT<jats:sub>RCA<\/jats:sub> attenuation\u2009\u2265\u2009-78.3 HU exhibited a greater frequency of maxLCBI<jats:sub>4mm<\/jats:sub>\u2009\u2265\u2009400 (66% vs. 26%, p\u2009&lt;\u20090.01), plaque burden\u2009\u2265\u200970% (94% vs. 74%, p\u2009=\u20090.02) and spotty calcification (49% vs. 6%, p\u2009&lt;\u20090.01). Whereas positive remodeling (63% vs. 41%, p\u2009=\u20090.07) did not differ between two groups. On multivariable analysis, maxLCBI<jats:sub>4mm<\/jats:sub>\u2009\u2265\u2009400 (OR\u2009=\u20094.07; 95%CI 1.12\u201314.74, p\u2009=\u20090.03), plaque burden\u2009\u2265\u200970% (OR\u2009=\u20097.87; 95%CI 1.01\u201361.26, p\u2009=\u20090.04), and spotty calcification (OR\u2009=\u200914.33; 95%CI 2.37\u201386.73, p\u2009&lt;\u20090.01) independently predicted high PCAT<jats:sub>RCA<\/jats:sub> attenuation. Of note, while the presence of only one plaque feature did not necessarily elevate PCAT<jats:sub>RCA<\/jats:sub> attenuation (p\u2009=\u20090.22), lesions harboring two or more features were significantly associated with higher PCAT<jats:sub>RCA<\/jats:sub> attenuation. More vulnerable plaque phenotypes were observed in patients with high PCAT<jats:sub>RCA<\/jats:sub> attenuation. Our findings suggest PCAT<jats:sub>RCA<\/jats:sub> attenuation as the presence of profound disease substrate, which potentially benefits from anti-inflammatory agents.<\/jats:p>","DOI":"10.1007\/s10554-023-02907-w","type":"journal-article","created":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T03:32:46Z","timestamp":1688009566000},"page":"1943-1952","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Characterization of plaque phenotypes exhibiting an elevated pericoronary adipose tissue attenuation: insights from the REASSURE-NIRS registry"],"prefix":"10.1007","volume":"39","author":[{"given":"Satoshi","family":"Kitahara","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Kataoka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Miura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuya","family":"Nishii","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunihiro","family":"Nishimura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kota","family":"Murai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takamasa","family":"Iwai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideo","family":"Matama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Honda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Fujino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuichi","family":"Yoneda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kensuke","family":"Takagi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumiyuki","family":"Otsuka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhide","family":"Asaumi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Fujino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenichi","family":"Tsujita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rishi","family":"Puri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J.","family":"Nicholls","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teruo","family":"Noguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,6,29]]},"reference":[{"issue":"2","key":"2907_CR1","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1056\/nejm199901143400207","volume":"340","author":"R Ross","year":"1999","unstructured":"Ross R (1999) Atherosclerosis\u2013an inflammatory disease. 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Other authors have nothing to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of National Cerebral and Cardiovascular Center (research project number: M30-084-6).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}