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Predicting mortality and no-reflow in STEMI patients using epicardial adipose tissue
Amr Mohamed1,2
1Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA.
Insights
Increased epicardial adipose tissue (EAT) thickness in ST-segment elevation myocardial infarction (STEMI) patients is linked to higher mortality and no-reflow risk. Echocardiography can measure EAT to predict these adverse outcomes.
Area of Science:
- Cardiology
- Medical Imaging
- Clinical Research
Background:
- Acute myocardial infarction (MI) is a primary cause of global mortality.
- ST-segment elevation myocardial infarction (STEMI) signifies severe coronary artery disease due to arterial occlusion.
- Primary percutaneous coronary intervention (PCI) is the standard reperfusion therapy for STEMI.
Purpose of the Study:
- To investigate the association between epicardial adipose tissue (EAT) thickness and adverse outcomes in STEMI patients.
- To determine if EAT thickness predicts the no-reflow phenomenon and mortality post-primary PCI.
Main Methods:
- 113 STEMI patients undergoing primary PCI were evaluated.
- Epicardial adipose tissue (EAT) thickness and left ventricular ejection fraction were assessed via echocardiography.
- Patients were stratified into two groups based on EAT thickness: <5 mm (Group I) and >5 mm (Group II).
Main Results:
- Epicardial fat thickness showed a significant correlation with the no-reflow phenomenon during catheterization.
- Increased EAT thickness was associated with poorer overall prognosis in STEMI patients.
- A cutoff of 5 mm EAT thickness was identified using ROC curve analysis.
Conclusions:
- Elevated EAT thickness may independently predict no-reflow and mortality in STEMI patients.
- Echocardiographic measurement of EAT thickness offers valuable prognostic information.
- EAT thickness serves as a potential biomarker for risk stratification in STEMI.
Background:
Acute myocardial infarction is a leading cause of morbidity and mortality worldwide. It occurs when irreversible myocardial cell damage or death occurs. ST-segment elevation myocardial infarction (STEMI) is the most serious presentation of atherosclerotic coronary artery disease. STEMI results from the occlusion of a major coronary artery. Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy. It should be performed by an experienced team within the shortest time possible from the first medical contact.
Hypothesis:
Increased mortality risk and no-reflow in STEMI patients with epicardial adipose tissue thickness (EAT) more than 5 mm compared to STEMI patients with EAT less than 5 mm.
Methods:
This study was conducted on 113 patients who presented to the cardiology department of Ain Shams university hospital with the first STEMI and underwent primary PCI. Medical treatment for STEMI was given to all subjects as per the guidelines. All patients underwent an echocardiographic evaluation of epicardial adipose tissue and left ventricular ejection fraction. Patients were divided into two groups using epicardial adipose tissue thickness of 5 mm as a cutoff point; this number was derived from the ROC curve. Group I: Included patients with EAT thickness less than 5 mm, including 44 patients (38.9%). Group II: Included patients with EAT thickness greater than 5 mm, including 69 patients (61.1%).
Results:
The current study showed that epicardial fat thickness significantly correlated with the no-reflow phenomenon in the cath lab and overall prognosis in patients with STEMI.
Conclusion:
Increased EAT thickness may be an independent predictor of the no-reflow phenomenon and mortality. Therefore, our study emphasizes that EAT thickness measured by echocardiography may provide additional and substantial information on the risk of no-reflow and mortality in STEMI patients.
