{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T23:48:30Z","timestamp":1790293710178,"version":"4.1.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T00:00:00Z","timestamp":1787356800000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81901740"],"award-info":[{"award-number":["81901740"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82471978"],"award-info":[{"award-number":["82471978"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82271993"],"award-info":[{"award-number":["82271993"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007129","name":"Natural Science Foundation of Shandong","doi-asserted-by":"publisher","award":["ZR2024MH069"],"award-info":[{"award-number":["ZR2024MH069"]}],"id":[{"id":"10.13039\/501100007129","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Postdoctoral Innovative Project of Shandong Province","award":["SDCX-ZG- 202303062"],"award-info":[{"award-number":["SDCX-ZG- 202303062"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The influence of sex on coronary inflammation in patients with nonobstructive coronary artery disease (CAD) remains unclear. This study aimed to determine sex differences in coronary inflammation, quantified by pericoronary fat attenuation index (pFAI) derived from coronary computed tomography angiography (CCTA), and their impact on clinical outcomes among patients with plaque-positive nonobstructive CAD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>This study retrospectively included 1395 patients with plaque-positive nonobstructive CAD who underwent CCTA (61 \u00b1 10 years, 55.2% males). Major adverse cardiovascular events (MACEs) were defined as cardiac death, nonfatal myocardial infarction, rehospitalization for heart failure or unstable angina, and late revascularization. After a median follow-up of 85 months (interquartile range: 72\u201399), 177 patients experienced MACEs. Male sex was independently associated with elevated coronary inflammation (pFAI &amp;gt; \u221270.1 HU; odds ratio = 1.36, P = 0.047). Male patients had a significantly higher cumulative rate of MACE than female patients (P &amp;lt; 0.001). Furthermore, patients with coronary inflammation (pFAI &amp;gt; \u221270.1 HU) exhibited significantly worse long-term outcomes than those without, and consistent findings were observed in both male and female subgroups (all P &amp;lt; 0.001). In multivariable Cox regression analysis, pFAI remained independently associated with MACEs in patients with nonobstructive CAD (hazard ratio = 2.33, P &amp;lt; 0.001) and provided incremental prognostic value beyond clinical variables and traditional CCTA metrics (area under the receiver operating characteristic curve: 0.683\u20130.781, P &amp;lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among patients with plaque-positive nonobstructive CAD, males exhibited worse long-term outcomes than females and showed a stronger association with coronary inflammation. pFAI is independently associated with long-term prognosis and may enhance risk stratification in these patients.<\/jats:p>\n                  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