Predictive Value of Pericoronary Adipose Tissue Attenuation Index and Left Main Coronary Artery Angle for High-Risk Plaques in Patients with Left-Dominant Coronary Artery Disease

Objective To evaluate the predictive value of pericoronary fat attenuation index (FAI) and left main coronary artery (LMCA) angle for high-risk plaques in left-dominant coronary artery disease (CAD) using coronary computed tomography angiography (CCTA). Methods This study was a single-center retrospective cross-sectional study. A total of 106 patients with left-dominant coronary artery disease (CAD) who underwent coronary computed tomography angiography (CCTA) at our institution between January 2024 and March 2025 were enrolled. Based on the characteristics of proximal left anterior descending artery (LAD) plaques, the patients were stratified into a high-risk plaque group (n = 45) and a non-high-risk plaque group (n = 61). Baseline characteristics were compared between the two groups. Multivariate logistic regression analysis was then performed to investigate the independent associations of the pericoronary fat attenuation index (FAI) and the angle of the left main coronary artery (LMCA) with the risk of coronary atherosclerosis and high-risk plaques. Additionally, receiver operating characteristic (ROC) curves were constructed to evaluate their predictive value for high-risk plaques in these patients. Results Baseline characteristics: Statistically significant differences were noted in age, pericoronary fat attenuation index (FAI), and coronary artery angle between the two groups (p < 0.05).Multivariate analysis: Both the pericoronary fat attenuation index (FAI) and the left main coronary artery (LMCA) angle were significantly higher in the high-risk plaque group than in the non-high-risk plaque group (P < 0.001), and these two factors were identified as independent risk factors.ROC analysis: The AUCs of FAI and LMCA angle alone were 0.729 and 0.698 respectively, while the AUC of their combined prediction was 0.791, which was significantly better than that of single indicators (P < 0.05). Conclusion The pericoronary fat attenuation index (FAI) and left main coronary artery (LMCA) angle were identified as independent predictors of proximal left anterior descending artery (LAD) high-risk plaque formation in patients with left-dominant coronary artery disease (CAD). The combined prediction model integrating both indicators significantly enhanced the diagnostic performance for high-risk plaque identification, which holds important implications for risk stratification and clinical management.