Prognostic value of epicardial adipose tissue assessed by cardiac magnetic resonance in patients with ST-elevation myocardial infarction after successful revascularization.

BACKGROUND

Epicardial adipose tissue (EAT) around the myocardium may play a role in coronary artery disease, yet its prognostic value in patients with ST-segment elevation myocardial infarction (STEMI) remains uncertain.

METHODS

Data from 540 STEMI patients enrolled in a registry study (NCT03768453) were analyzed. Cardiac magnetic resonance (CMR) cine sequences were used to measure EAT volume. The primary endpoint was a composite of major adverse cardiovascular events (MACE). The Cox proportional hazards model was used to assess the association between EAT volume and MACE. Correlation analyses were performed to explore relationships between EAT volume and myocardial injury markers. In addition, paired t-tests were applied to compare changes in EAT volume over the 6-month follow-up.

RESULTS

During a median follow-up of 4.5 years, MACE occurred in 65 patients (12.0%). Patients who experienced MACE had a significantly higher EAT volume (39.6 vs. 33.4 mL, P < 0.001) than those without MACE. EAT volume was an independent predictor of MACE after adjustment for clinical factors (HR = 1.08, 95% CI: 1.02-1.16, P = 0.037) and CMR parameters (HR = 1.04, 95% CI: 1.02-1.07, P < 0.001). EAT volume was significantly correlated with myocardial injury markers, including infarct size (r = 0.15, P = 0.001) and microvascular obstruction (r = 0.15, P = 0.001). EAT volume remained stable at the 6-month follow-up (34.6 vs. 35.6 mL, P = 0.181).

CONCLUSIONS

EAT measured non-invasively by CMR is an independent prognostic biomarker for adverse outcomes in STEMI patients. It may serve as a promising imaging marker for risk stratification in this patient population.