Degree of coronary artery stenosis is only one of many characteristics describing plaques, and evidence suggests that lesions most at risk of developing complications of CAD are not necessarily those with the greatest degree of stenosis, but those that present a vulnerable plaque, a kind of atheromatous plaque that is particularly. High-risk plaque features that are associated with a significantly higher risk of the occurrence of an acute coronary artery syndrome, include a thin fibrous cap, large lipid-rich necrotic core, increased plaque inflammation, positive vascular remodeling or low-attenuation plaques, increased vasavasorum neovascularization, and intra-plaque hemorrhage positive vessel remodeling.

 

These pathological characteristics are considered to make plaques more “high-risk” or “vulnerable”, meaning they are more prone to disruption with subsequent superimposed thrombosis, which is the prime mechanism of most acute coronary syndromes (ACS). A number of studies have focused more specifically on the association of EAT and high risk coronary lesions, and found that EAT is in fact positively associated with high risk plaque characteristics such as positive remodeling, spotty calcification and low-attenuation plaque.

 

A study by Schlett and colleagues suggested that EAT was significantly associated with high-risk coronary artery lesion morphology. They found that EAT was nearly twice higher in patients with high-risk coronary lesions than in those without CAD. Furthermore, they also found that EAT was still significantly higher in patients with high-risk lesions compared to patients with CAD but with no evidence of high-risk plaque morphology. In summary, they concluded that low EAT volume effectively excluded the presence of high-risk coronary morphology.