Epicardial fat thickness predicts severe coronary artery disease and high mortality risk among ST-elevation myocardial infarction patients

Abstract

Background: Epicardial adipose tissue has been identified as a significant marker in the assessment of coronary artery disease (CAD), with a possible impact on the development of acute coronary events including ST-elevation myocardial infarction (STEMI). Aim: To assess the association and predictability of echocardiographic-measured epicardial fat thickness (EFT) for the severity of CAD and mortality risk among STEMI patients. Methods: This study included 159 STEMI patients who underwent primary percutaneous coronary intervention (PPCI) and survived the in-hospital duration. Anthropometric measurements, lipid profiles, and angiographic data were recorded. The correlations between echo-measured EFT and CAD severity indicated by the syntax score (SS) were assessed. In-hospital and 6-month major adverse cardiovascular events (MACE) were reported, and mortality risk was evaluated using the Grace score. Results: Among the study population, 104 patients (65.4%) had low SS, 45 patients (28.3%) had moderate SS, and 10 patients (6.3%) had high SS. STEMI patients with moderate/high SS had significantly larger EFT. EFT showed a significant correlation with BMI (r = 0.57), fat mass (kg) (r = 0.44), LDL (r = 0.40), the syntax score (r = 0.74), and the Grace score (r = 0.68), (p < 0.001 for all). Our ROC-derived cutoff value of EFT ≥ 5.45 mm significantly discriminated STEMI patients with moderate/high-SS, high coronary thrombus burden, 6-months high mortality risk, and 6-months MACE with reasonable respective sensitivity and specificity. Increased EFT independently predicted moderate/high-SS and high mortality risk on multivariable regression analysis. Conclusion: Echo-measured EFT ≥ 5.45 mm might be a reliable non-invasive marker for predicting CAD severity, high coronary thrombus burden, 6-months high mortality risk, and 6-months MACE among STEMI patients.