Evaluating Coronary Arteries and Predicting Major Adverse Cardiovascular Events in Patients with Esophageal Cancer Using Coronary CT Angiography.

Purpose To evaluate alterations in coronary arteries in individuals with esophageal squamous cell carcinoma (ESCC) who received chemotherapy or chemoradiotherapy using coronary CT angiography (CCTA) parameters and explore their association with major adverse cardiovascular events (MACEs). Materials and Methods Between July 2020 and August 2022, individuals with ESCC scheduled for chemotherapy or chemoradiotherapy who underwent CCTA were prospectively included. MACEs were defined as myocardial infarction, stroke, complete heart block, cardiovascular death, or rehospitalization due to heart failure or aggravated angina symptoms. The outcome time frame was measured from treatment initiation until the occurrence of MACEs or the end of follow-up, whichever occurred first. Associations between CCTA parameters and MACEs were analyzed by Cox regression analyses. Results Among the 140 enrolled participants (mean age ± SD, 65 years ± 8.39; 76 [54%] male), 60 received chemotherapy, and 80 received chemoradiotherapy. The CT fractional flow reserve (FFR) decreased and the fat attenuation index (FAI) increased after chemotherapy or chemoradiotherapy. Moreover, a lower CT FFR (left anterior descending artery [LAD], 0.75 vs 0.82; left circumflex artery [LCX], 0.74 vs 0.77; right coronary artery [RCA], 0.74 vs 0.77; P < .001) and higher FAI (LAD, -70.0 vs -75.0 HU; LCX, -75.0 vs -77.5 HU; RCA, -76.0 vs -78.5 HU; P < .001) were observed after chemoradiotherapy than after chemotherapy. The baseline FAIs of the LAD, LCX, and RCA were independently associated with the occurrence of MACE (hazard ratio = 3.99, 3.85, and 3.41, respectively; P < .001). Conclusion CT FFR decreased and the FAI increased after chemotherapy or chemoradiotherapy in individuals with ESCC. The baseline FAI was a predictor of MACEs. Keywords: CT-Coronary Angiography, Radiation Therapy/Oncology, Cardiac, Coronary Arteries, Esophagus, Esophageal Neoplasms, Chemoradiotherapy, Fractional Flow Reserve, Major Adverse Cardiac Events Supplemental material is available for this article. © RSNA, 2026.