Effect of Premature Acute Coronary Syndrome on Ocular Hemodynamics

Background: Premature acute coronary syndrome (ACS) has attracted attention due to high rates of recurrent ischemic events and mortality. We aimed to explore the characteristic changes of the ocular hemodynamics in patients with premature ACS. Methods: 116 participants (30 healthy controls, 30 with premature ACS, 56 with non-premature ACS) undergoing computed tomographic angiography (CTA) were enrolled. Head and neck CTA images were used to construct three-dimensional models of participants' ophthalmic arteries (OAs). Morphological parameters were measured, and numerical simulations based on computational fluid dynamics were used to acquire hemodynamic parameters of OAs. Retinal and choroidal vascular parameters were obtained by color fundus images and optical coherence tomography. Results: No significant differences in morphology of the OAs among the three groups. Hemodynamic simulation showed a significantly slower OA blood velocity in patients with premature ACS than in the control (P < 0.001) and non-premature groups (P = 0.038). Lower wall shear stress was found in patients with premature ACS than that in control (P = 0.015) and non-premature groups (P = 0.049). Patients with non-premature ACS had a higher wall pressure than healthy controls (P = 0.035). Mass flow ratios were decreased in all ACS groups (P < 0.001). Patients with premature ACS had smaller central retinal artery equivalent and choroidal vascularity index. The hemodynamic parameters of OA were correlated with several clinical indicators. Conclusions: Hemodynamics changes of OA and microcirculation of the retina and choroid in patients with premature ACS appeared before OA morphological changes. Premature ACS may aggravate ocular ischemic lesions more than non-premature ACS. Our findings could potentially guide future studies into a better understanding of the association of ocular lesions with systemic conditions in patients with premature ACS.