Prognostic incremental value of perivascular adipose tissue in myocardial infarction with non-obstructive coronary arteries: a multicenter cohort study

Background: Perivascular adipose tissue (PVAT) is recognized as a key contributor to atherosclerosis and adverse clinical outcomes. However, its relationship with metabolic status and prognosis in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) remains unclear. The aim of this study was to investigate the relationship between PVAT and clinical prognosis in patients with MINOCA, and to assess its incremental predictive value beyond the traditional metrics.

Methods: A simple scoring tool, the PVAT score, was constructed based on cardiac magnetic resonance (CMR)-derived region-specific PVAT indicators. A total of 272 patients with MINOCA and 204 healthy controls were enrolled. The prognostic increment was assessed by analyzing the association of PVAT index and metabolic index with composite major adverse cardiovascular events (MACE).

Results: The region-specific PVAT index and PVAT score were significantly higher in patients with MINOCA than in controls. Over a median 3.2-year follow-up, 57 MACEs occurred. In addition to age [hazard ratio (HR): 1.09, 95% confidence interval (CI): 1.05–1.13, P<0.001], late gadolinium enhancement positivity (HR: 1.98, 95% CI: 1.16–3.39, P=0.012), triglyceride-glucose (TyG) index (HR: 4.28, 95% CI: 1.92–9.51, P=0.016), a higher PVAT score (HR: 3.84, 95% CI: 1.52–9.72, P=0.004) was significantly associated with an increased risk of MACE. Notably, the prognostic association of PVAT score was significantly stronger in MINOCA patients with concomitant diabetes mellitus (DM) (P<0.001).

Conclusions: Region-specific PVAT indicators and PVAT score were increased and associated with poorer prognosis in patients with MINOCA. The PVAT score provided incremental prognostic value beyond established clinical predictors, enabling improved risk stratification, particularly in the DM subgroup.