What CCTA-Based AI Detection of Coronary Inflammation May Reveal About Patients with No Traditional CV Risk Factors
Elevated coronary inflammation, measured with the CCTA-derived and AI-enabled perivascular fat attenuation index (FAI) score, was associated with over a 12-fold higher risk for cardiovascular mortality in patients with no diabetes, hypertension, smoking history or obesity, according to new research presented at the European Society of Cardiology (ESC) Congress.
New research continues to affirm the prognostic utility of the coronary computed tomography angiography (CCTA)-derived perivascular fat attenuation index (FAI) score in assessing cardiovascular risks for patients without common risk factors such as smoking history, obesity, hypertension and diabetes.
In a multicenter longitudinal study, recently presented at the European Society of Cardiology (ESC) Congress, researchers assessed the AI-powered FAI score’s quantification of coronary inflammation with a review of CCTA data for 73,689 patients and a median follow-up period of 6.6 years.
While patients without standardized modifiable cardiovascular risk factors (SMuRFs) comprised 18 percent of the cohort, they had 8.9 percent of total major adverse cardiovascular events (MACE) and accounted for 7.8 percent of total cardiovascular-related deaths, according to the study.
Among patients without SMuRFs, the study authors found that patients with increased FAI scores in the 90th centile had over a fourfold higher risk for MACE and over a 12-fold higher risk for cardiovascular mortality in comparison to those in the bottom quartile for FAI score.
“These findings highlight the limitations of SMuRF-based risk assessment and support further evaluation of imaging biomarkers of vascular inflammation to enable more precise CV risk stratification and earlier preventive intervention,” noted lead study author Leanne Eveson, MD, who is affiliated with the Division of Cardiovascular Medicine in the Radcliffe Department of Medicine at the Oxford NIHR Biomedical Research Centre and the University of Oxford in Oxford, United Kingdom, and colleagues.
The researchers also found increased risks of 42 percent, 27 percent and 16 percent for cardiovascular death, ischemic stroke and myocardial infarction, respectively, for each increase in the standard deviation of the mean FAI score.
“The strength of these associations was progressively attenuated with increasing SMuRF burden even after adjustment for CAD severity, suggesting that coronary inflammation plays a proportionally greater role in risk among SMuRFless individuals,” added Eveson and colleagues.
Reference
- Eveson L, Chan K, Wahome E, et al. Coronary inflammation predicts cardiovascular risk in the absence of standard modifiable risk factors (SMuRFs): the ORFAN study. Presented at the European Society of Cardiology (ESC) Congress, August 28-31, 2026, Munich, Germany.
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