Epicardial adipose tissue and cardiovascular outcome in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Abstract

Aims: We investigated the association between epicardial adipose tissue (EAT) thickness and cardiovascular outcomes in a cohort of high-risk patients with acute coronary syndrome undergoing percutaneous coronary intervention. Methods: Of 1198 patients undergoing percutaneous coronary intervention, transthoracic echocardiography was performed in 438 patients during the index hospitalization. EAT thickness was measured in the parasternal long-axis view perpendicularly on the free wall of the right ventricle at end-systole in three consecutive cardiac cycles and then averaged. As the primary outcome measure, a composite of major adverse cardiovascular events – including cardiovascular death, non-fatal myocardial infarction and non-fatal stroke – was investigated after three years of follow-up. Results: Patients were included between 2004 and 2012 and 293 (66.9%) were men. The median EAT thickness was 2.65 mm (interquartile range 2.00–3.00). EAT was correlated with body mass index (R=0.404; p<0.001), weight (R=0.314; p<0.001), baseline creatinine (R=0.118; p=0.014) and baseline glucose (R=0.129; p=0.007). After a follow-up period of three years, a major adverse cardiovascular event occurred in 64 patients (14.6%) corresponding to 36 (8.2%) with cardiovascular death, 21 (4.8%) with myocardial infarction and seven (1.6%) with stroke. Regarding the primary endpoint, EAT thickness revealed a significant predictive effect on univariate Cox regression (hazards ratio 1.479, 95% CI 1.192–1.953; p=0.006) and multivariate Cox regression analysis (hazards ratio 1.524, 95% CI 1.011–2.267; p=0.038) after adjusting for established cardiovascular confounders. Conclusions: In a cohort of high-risk patients with acute coronary syndrome undergoing percutaneous coronary intervention, EAT was associated with established markers of cardiovascular death and had a predictive value for the three-year cardiovascular outcome.