Impact of epicardial adipose tissue thickness on coronary artery thrombus burden in patients with ST segment elevation myocardial infarction treated by primary percutaneous coronary interventions

Figures & data

Table 1. Comparison between the two studied groups according to demographic, clinical, and laboratory characteristics.

Demographic data	Total (n = 80)	Group I (n = 25)	Group II (n = 55)	P
Male gender (NO %)	70(87.5%)	20(80%)	50(90.9%)	^FEp = 1.000
Age(years)	54.35 ± 8.80	55.68 ± 8.24	53.75 ± 9.06	0.366
BMI (kg/m^2)	28.72 ± 5.35	26.44 ± 3.80	29.75 ± 5.65	0.003*
Cardiovascular risk factors (NO %)
Smoker	60(75.0%)	21(84%)	39(70.9%)	0.210
Diabetes mellitus	26(32.5%)	8(32.0%)	18(32.7%)	0.949
Hypertension	29(36.3%)	10(40.0%)	19(34.5%)	0.638
Family history for CAD	9(11.3%)	2(8.0%)	7(12.7%)	^FEp = 0.712
Pain to FMC (hours)	5.16 ± 3.61	5.74 ± 3.76	4.89 ± 3.55	0.416
Killip classification (NO %)
1	79(98.8%)	25(100.0%)	54(98.2%)	^FEp=1.000
2	1(1.3%)	0	1(1.8%)
Heart rate(bpm)	92.96 ± 13.23	93.31 ± 14.79	92.35 ± 11.56	1.000
Systolic BP(mmHg)	123.5 ± 20.28	128.4 ± 23.08	125.1 ± 17.27	0.481
Diastolic BP(mmHg)	79.88 ± 13.82	82.31 ± 15.05	78.70 ± 13.18	0.378
Drugs administrated (NO %)
ASA and clopidogrel	25(31.3%)	9(36.0%)	16(29.1%)	0.537
ASA and ticagrelor	55(68.8%)	16(64.0%)	39(70.9%)
Anterior STEMI (NO. %)	46(57.5%)	16(64.0%)	30(54.5%)	0.971
Hemoglobin level (g/dl)	14.17 ± 1.80	13.98 ± 1.59	14.25 ± 1.90	0.531
Serum Creatinine (mg/dl)	1.01 ± 0.29	1.03 ± 0.26	1.0 ± 0.30	0.447
Serum total cholesterol (mg/dl)	197.8 ± 62.75	194.6 ± 56.84	199.3 ± 65.71	0.983
LDL (mg/dl)	129.7 ± 59.59	127.8 ± 51.99	130.5 ± 63.17	0.921
HDL (mg/dl)	35.83 ± 8.12	34.59 ± 9.31	36.39 ± 7.54	0.362
Triglycerides (mg/dl)	160.2 ± 65.41	155.0 ± 49.24	162.6 ± 71.85	0.913
Glycated hemoglobin (%)	6.22 ± 1.44	6.11 ± 1.41	6.27 ± 1.46	0.835
Troponin I (ng/ml)	9.59 ± 17.07	6.90 ± 14.93	15.52 ± 20.11	0.025*
CK-MB (ng/ml)	40.96 ± 62.45	32.58 ± 56.85	59.40 ± 71.09	0.032*

ASA: acetyl salicylic acid; BMI: body mass index; BP: blood pressure; CAD: coronary artery disease; FMC: first medical contact; HDL: high-density lipoprotein; LDL: low-density lipoprotein; STEMI: ST elevation myocardial infarction; *Statistically significant at p ≤ 0.05

Table 2. Comparison between the two studied groups according to the angiographic results.

	Total (n = 80) No. (%)	Group I (n = 25) No. (%)	Group II (n = 55) No. (%)	P
Use of GpIIb/IIIa inhibitors	28(35.0)	5(20.0)	23(41.8)	0.058
Thrombus aspiration	3(3.8)	0	3(5.5)	^FEp = 0.548
Balloon pre-dilation	63(78.8)	15(60.0)	48(87.3)	0.006*
Balloon post-dilation	49(61.3)	14(56.0)	35(63.6)	0.516
Culprit vessel for PPCI				0.634
LAD	46(57.5)	16(64.0)	30(54.5)
RCA	29(36.3)	7(28.0)	22(40.0)
LCX	3(3.8)	1(4.0)	2(3.6)
OM1	2(2.5)	1(4.0)	1(1.8)
Number of stents in the culprit vessel
1stent	69(86.3)	24(96.0)	45(81.8)	^FEp = 0.159
2stents	11(13.8)	1(4.0)	10(18.2)
Stent’s drug type
Biolimus A9	16(20.0)	4(16.0)	12(21.8)	^MCp = 0.546
Everolimus	40(50.0)	11(44.0)	29(52.7)
Sirolimus	11(13.8)	4(16.0)	7(12.7)
Zotarolimus	13(16.3)	6(24.0)	7(12.7)
TIMI flow grade post-PPCI
Grade (0, and 1)	0	0	0	^FEp = 0.425
Grade 2	7(8.8)	1(4.0)	6(10.9)
Grade 3	73(91.3)	24(96.0)	49(89.1)

LAD: left anterior descending artery; LCX: left circumflex artery; OM1: obtuse marginal artery; RCA: right coronary artery; PPCI: primary percutaneous coronary interventions; TIMI: thrombolysis in myocardial infarction; *: statistically significant at p ≤ 0.05.

Figure 1. Shows EAT thickness of 3.07 mm in one STEMI patients with angiographically high thrombus burden.

Figure 2. ROC curve that predict EAT thickness cutoff value of 2.48 mm to predict high thrombus burden in STEMI patient.

Table 3. Comparison between the two studied groups according to echocardiographic results.

	Total (n = 80)	Group I (n = 25)	Group II (n = 55)	P
LAVI(ml/m^2)(mean ± SD)	30.24 ± 6.65	34.04 ± 5.59	26.50 ± 6.69	0.002*
LVEDV (ml)	118.6 ± 32.97	113.3 ± 33.49	121.0 ± 32.76	0.510
LVESV (ml)	60.29 ± 25.79	53.52 ± 22.13	63.37 ± 26.92	0.063
LVEF %	49.94 ± 10.92	52.36 ± 11.15	48.84 ± 10.74	0.184
E-wave maximum velocity (m/s)	0.64 ± 0.19	0.61 ± 0.18	0.65 ± 0.20	0.415
e’-wave maximum velocity (m/s)	0.066 ± 0.047	0.078 ± 0.076	0.060 ± 0.024	0.724
E/e’ ratio	11.30 ± 4.71	10.68 ± 3.59	11.58 ± 5.14	0.783
WMSI	1.37 ± 0.31	1.29 ± 0.23	1.41 ± 0.33	0.209
EAT thickness (mm)	3.39 ± 1.77	2.51 ± 1.44	3.79 ± 1.77	<0.001*
Mitral valve regurgitation (MR) severity				MCp 0.624
No MR	47 (58.8%)	16 (64.0%)	31 (56.4%)
Mild MR	28 (35.0%)	7 (28.0%)	21 (38.2%)
Moderate MR	5 (6.3%)	2 (8.0%)	3 (5.5%)

E wave: early mitral inflow velocity; e’ wave: early diastolic mitral annulus velocity; EAT: epicardial adipose tissue; LAVI: left atrial volume index; LVEDV: left ventricular end diastolic volume; LVEF: left ventricular ejection fraction; LVESV: left ventricular end systolic volume; MR: mitral regurgitation; WMSI: wall motion score index; *statistically significant at p ≤ 0.05.

Table 4. Univariate logistic regression of different parameters to predict the thrombus burden in STEMI patients undergoing PPCI.

	Univariate
	P value	OR (LL – UL 95%C.I)
Clinical and laboratory parameters
Male gender	0.783	0.722 (0.071–7.307)
Age	0.362	0.974 (0.922–1.030)
BMI	0.013*	1.144 (1.029–1.272)
Smoking	0.490	0.614 (0.153–2.457)
Diabetes mellitus	0.949	1.034 (0.376–2.843)
Hypertension	0.638	0.792 (0.299–2.097)
Family history for CAD	0.539	1.677 (0.323–8.717)
Pain to FMC time	0.329	0.937 (0.823–1.067)
Killip classification	1.000	–
Serum total cholesterol	0.752	1.001 (0.994–1.009)
LDL level	0.849	1.001 (0.993–1.009)
HDL level	0.358	1.029 (0.968–1.094)
TG level	0.629	1.002 (0.994–1.009)
HbA1c	0.650	1.082 (0.771–1.518)
Anterior STEMI	0.429	0.675 (0.255–1.788)
Angiographic parameters
Culprit vessel LAD	0.429	0.675 (0.255–1.788)
Culprit vessel RCA	0.303	1.714 (0.614–4.784)
Culprit vessel LCX + OM1	0.665	0.663 (0.104–4.242)
Use of ASA and clopidogrel	0.537	0.729 (0.268–1.988)
Use of ASA and ticagrelor	0.537	1.371 (0.503–3.737)
GpIIb/IIIa inhibitors usage	0.064	2.875 (0.941–8.784)
Number of stents in the culprit vessel	0.121	5.333 (0.644–44.188)
Echocardiographic parameters
EAT thickness	0.005*	1.898 (1.217–2.961)
LVEDV	0.333	1.008 (0.992–1.024)
LVESV	0.115	1.019 (0.995–1.044)
LVEF %	0.183	0.970 (0.928–1.014)
Wall motion score index	0.115	4.208 (0.704–25.142)
E wave maximum velocity	0.410	2.850 (0.236–34.500)
e’ wave maximum velocity	0.209	0.0001 (9.3 × 10^−11 −156.96)
E/e’ ratio	0.429	1.044 (0.938–1.163)
Mild MR	0.413	1.548 (0.544–4.410)
Moderate MR	0.790	0.774 (0.117–5.115)

OR: Odd`s ratio C.I: Confidence interval LL: Lower limit UL: Upper Limit.

*Statistically significant at p ≤ 0.05.