The relationship between epicardial adipose tissue and ST-segment resolution in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Abstract

The relationship between epicardial adipose tissue (EAT) and coronary artery disease has been predominantly demonstrated in the last two decades. The aim of this study was to investigate the predictive value of EAT thickness on ST-segment resolution that reflects myocardial reperfusion in patients undergoing primary percutaneous coronary intervention (pPCI) for acute ST-segment elevation myocardial infarction (STEMI). The present study prospectively included 114 consecutive patients (mean age 54 ± 10 years, range 35-83, 15 women) with first acute STEMI who underwent successful pPCI. ST-segment resolution (ΔSTR) <70 % was accepted as ECG sign of no-reflow phenomenon. The EAT thickness was measured by two-dimensional echocardiography. EAT thickness was increased in patients with no-reflow (3.9 ± 1.7 vs. 5.4 ± 2, p = 0.001). EAT thickness was also found to be inversely correlated with ΔSTR (r = -0.414, p = 0.001). Multivariate logistic regression analysis demonstrated that EAT thickness independently predicted no-reflow (OR 1.43, 95 % CI 1.13-1.82, p = 0.003). Receiver operating characteristic curve analysis demonstrated good diagnostic accuracy for EAT thickness in predicting no-reflow [area under curve (AUC) = 0.72, 95 % CI 0.63-0.82, p < 0.001]. In conclusion, increased EAT thickness may play an important role in the prediction of no-reflow in STEMI treated with pPCI.

Original research. The Assessment of Epicardial Adipose Tissue in Acute Coronary Syndrome Patients. A Systematic Review

“…[38][39][40][41][42][43][44][45] Table 1 presents a summary of the included manuscripts. All systematized manuscripts contain a concise and clear portrayal of the inclusion and exclusion criteria and the method for assessing EAT, either through cardiac CT or TTE (Table 1).…”

“…38,[43][44][45] One study 43 found a significant association between EAT and GRACE scores (p <0.001), though this was not corroborated by other studies. 38 The angiographic SYNTAX score for coronary lesion severity and the clinical TIMI risk score for adverse coronary events were also found to be significantly linked with EAT.…”

“…42 Most researchers (n = 6) used the Receiver Operator Characteristics (ROC) curve and the area under the curve for the determination of the cut-off value for EAT values that predicted the study outcome. [37][38][39][40][41]45 All selected articles used Spearman or Pearson correlation coefficient statistics for evaluating the link between epicardial fat and other clinical and laboratory variables.…”

“…[38][39][40][41][43][44][45] Zencirci et al (2014) hypothesized that there is an inverse association between the EAT and the STsegment resolution following primary PCI for acute STE-MI. 45 Other studied risk scores are the SYNTAX score for coronary atherosclerosis severity, the GRACE and TIMI risk scores for survival following an acute cardiac event,…”

“…45 ST-segment resolution is a surrogate for tissue level reperfusion, illustrating the no-reflow phenomenon after primary PCI, and the lack of ST-segment regression after PCI has been proved to be a predictor for in-hospital mortality rates. …”