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Funding Acknowledgements Nothing to declare OnBehalf None Background Peri-coronary fat attenuation index (pFAI) has emerged as a clinical marker of coronary inflammation, which is measurable from standard coronary CT angiography (CCTA). It compares well with gold-standard methods for the assessment of coronary inflammation and can predict future cardiovascular events. pFAI could prove invaluable to differentiate an inflammatory from noninflammatory coronary artery status, helping unravel the mechanisms subtending an event classified as myocardial infarction with nonobstructive coronary arteries (MINOCA) or Tako-Tsubo syndrome (TTs). Methods and Results Patients admitted with MINOCA and TTs diagnosis between 2011 and 2018, who had both CCTA and CMR performed during or shortly after the acute phase, were selected and pFAI measured in their index CCTA. pFAI was also measured in a control subjects who had CCTA for atypical chest pain work-up, no obstructive coronary artery disease found in their CCTA and no cardiac events at a minimum 2-year follow-up. In the n = 106 MINOCA/TTs patients selected, mean pFAI averaged for the 3 coronary arteries was -68.37 ± 8.29 vs -78.03 ± 6.20 in the n = 106 controls (p &amp;lt; 0.0001) and the statistical difference was confirmed also when comparing mean pFAI in each single coronary artery between MINOCA/TTs and controls (p &amp;lt; 0.0001). Non-obstructive coronary plaques at CCTA, and high-risk plaques in particular, were also more frequently found (p &amp;lt; 0.01) in the MINOCA/TTs group compared with controls. Conclusions In MINOCA and TTs patients, CCTA is not only able to detect otherwise angiographically invisible atherosclerotic plaques, but its diagnostic yield can be further expanded using the simple off-line measurement of pFAI for the characterization of peri-coronary fat tissue. In MINOCA/TTs mean pFAI clearly demonstrates higher values in comparison with controls, a finding which has been previously associated with coronary artery inflammation. We speculate that this newly-available diagnostic tool in the future may help select patients for new therapies, for example therapies targeting coronary inflammation. I was able to build a table. Abstract 1176 Figure.

1176 Coronary inflammation by CT peri-coronary fat attenuation in MINOCA and Tako-Tsubo syndrome