The impact of epicardial adiposity on STEMI outcomes: Insights from a prospective cohort

Purpose: Cardiovascular diseases, primarily driven by atherosclerosis, remain the leading cause of death worldwide. Key risk factors include diabetes, hyperlipidemia, hypertension, smoking, genetic predispositions and notably, obesity-related visceral adipose tissue (VAT). Like VAT, epicardial adipose tissue (EAT) influences heart function by releasing inflammatory cytokines. This study evaluated the relationship between EAT thickness and coronary artery disease severity, its interaction with risk factors, and its prognostic value for major cardiac and cerebrovascular events in ST-segment elevation myocardial infarction (STEMI) patients after percutaneous intervention (PCI). Methods: We analyzed 138 STEMI patients (124 males and 14 females) treated with primary PCI at our centre, documenting medical and demographic data, cardiovascular history, risk factors, time metrics, physical and clinical examinations, EAT thickness, and biochemical parameters. Follow-ups at 1 and 6 months post-discharge tracked major cardiovascular events. Results: The average age of the patients was 55.14 ± 12.83 years, predominantly male (89.9%), with varying prevalences of diabetes (22.5%), hypertension (38.4%), hyperlipidemia (37%), metabolic syndrome (32.6%), and family history of cardiovascular disease (47.1%). EAT thickness ranged from 1.5 to 11 mm, averaging 3.91 ± 1.42. Patients were divided into tertiles by EAT thickness, showing significant differences in age, weight, body mass index (BMI), thrombolysis in myocardial infarction (TIMI) scores, and number of affected vessels but not in mortality (7.2%), Major adverse cardiac and cerebrovascular events (MACCE) (13.8%), or combined endpoint outcomes across tertiles. Conclusion: No correlation was found between EAT thickness and mortality or MACCE in STEMI patients, highlighting the need for validation in long-term studies.