Impact of epicardial adipose tissue on coronary arteries thrombus burden and early outcomes in STEMI patients

Evaluation the relationship between the epicardial adipose tissue thickness (EAT), the coronary arteries thrombus burden and the early major adverse cardiovascular events (MACE) in patients presented with STEMI undergoing primary percutaneous coronary intervention.

The study was prospective and included patients (n = 80) who were referred to the cardiology department in Alexandria University Hospitals with STEMI between the 1st of March 2021 and the last day of August 2022. Patient clinical, laboratory, angiographic and echocardiographic data were described. Patients were put under observation to detect the occurrence of any major adverse cardiovascular events either in hospital or during a period of 30 days follow up.

Special concerns for measuring EAT as an echo free space between the myocardium and visceral epicardial and measured perpendicular to the free wall of the right ventricle in parasternal long and short axis views at end diastole and angiographic assessment of thrombus burden was scored as follows: 0 (no thrombus), 1 (possible thrombus), 2 (definite thrombus < 0.5× reference vessel diameter), 3 (definite thrombus 0.5–2× reference vessel diameter), 4 (definite thrombus >2× reference vessel diameter), and 5 (complete vessel occlusion). According to thrombus grade the patients were grouped as low thrombus burden (grades 0–3) and high thrombus burden (grades 4 and 5).

25 subjects were in the low thrombus burden group and 55 in the high thrombus burden group. There were no differences in the two groups for age, sex, smoking and drug addiction status, family history of coronary artery disease, diabetes mellitus, hypertension, and total cholesterol, triglyceride, LDL-C and HDL-C, The mean Wall motion score and Wall motion score index.

The means levels of high sensitivity troponin I and Creatine Kinase MB are measured higher in the low thrombus burden group with statistically significant difference (P = 0.025) and (P = 0.032).

Balloon predilation was statistically significant difference between the two groups (P = 0.006). Thrombus’ aspiration, balloon post dilation of the culprit vessel, GpIIb/IIIa inhibitors, and one stent only were insignificant difference between the two groups. The receiver operating characteristic curve analysis was undergone to determine the cutoff value of EAT to predict the presence of high thrombus burden setting a significance level at P < 0.05. The thickness of 2.48 mm for EAT has 74.55% sensitivity and 72.0% specificity for prediction of the high thrombus burden.

The predictors of the high thrombus burden were analyzed by univariate analysis shows EAT, the waist circumference, Wight, the body mass index, and balloon predilation were found as an independent predictors of high thrombus burden. The multivariate analysis shows EAT and balloon predilation were found as an independent predictors of high thrombus burden.

The overall MACE at 30 day follows up has statistically insignificant difference between low and high thrombus burden groups. There was statistically insignificant difference between patients with or without MACE according to epicardial adipose tissue thickness.

EAT was an independent predictor of coronary thrombus burden in STEMI patients.

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