Epicardial Pad of Fat as a Predictive of No-reflow following Primary PCI for STEMI and its Correlation with Mortality Risk using GRACE Score

Abstract

SUMMARY T his study was conducted on 113 patients who presented to the cardiology department of Ain Shams university hospital, with first acute anterior STEMI and underwent primary PCI. Patients admitted to the coronary care unit were analyzed thoroughly and data was recorded {Full history taking, clinical examination, 12 lead surface ECG, CK total and CK-MB, coronary angiographic details and transthoracic echocardiography in the first 48 hours}. Medical treatment of STEMI was given to subjects as per hospital protocol. All patients, during admission after AMI were subjected to echocardiographic evaluation of epicardial adipose tissue and LVEF. Patients were further divided into two groups using epicardial adipose tissue thickness of 5 mm as a cut off point, this number was derived from the ROC curve and also from a study made by (188). Group I: Included patients EAT thickness less than 5 mms and it included 44 patients (38.9%). Group II: Included patients with EAT thickness greater than 5 mms and it included 69 patients (61.1%). Both groups were studied as regard epicardial adipose tissue thickness relation to the risk of no-reflow and to the mortality risk using GRACE score. Both groups were age and sex matched with homogenous risk factors for CAD. At univariate analysis for clinical data, group II (EAT > 5mm) showed statistically significantly increase in mortality risk using GRACE mortality risk, with no statistically significant difference as regard the location of infarction (anterior vs non anterior) BMI and pain to door time. Meanwhile for coronary angiographic data, univariate analysis showed statistically significant lower TIMI flow and statistically significantly greater multivessel affection in group II patients. The current study showed that epicardial fat thickness was significantly correlated with prognosis in patients with ACS. This suggests that echocardiographic epicardial fat thickness could be applied as predictive marker of prognosis in patients with ACS. EAT thickness determined on echocardiography may provide additional and substantial information on risk of no-reflow in STEMI patients treated with primary PCI.