Predicting mortality and no-reflow in STEMI patients using epicardial adipose tissue

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.

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.

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%).

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.

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.