High levels of pericoronary adipose tissue inflammation are associated with coronary atherosclerosis independent of epicardial adipose tissue volume in patients with chronic coronary syndrome

• This study demonstrates that distinct phenotypes based on ectopic fat volume and composition-the volume of epicardial adipose tissue (EAT) and the inflammation status of pericoronary adipose tissue (PCAT)-can characterize coronary atherosclerotic disease burden in patients with chronic coronary syndrome.• While both increased EAT volume and PCAT inflammation have been reportedly associated with coronary artery disease (CAD) and cardiovascular events, evidence investigating the association of EAT volume and PCAT inflammation with CAD disease burden is limited.• Patients with increased EAT volume are at an elevated risk for coronary artery calcification and increased plaque burden, regardless of PCAT inflammation. In contrast, among patients without increased EAT volume, increased PCAT inflammation is correlated with an increased risk of coronary artery calcification and plaque burden.