# Epicardial fat thickness predicts severe coronary artery disease and high mortality risk among ST-elevation myocardial infarction patients

## TL;DR

Thicker epicardial fat is linked to more severe heart disease and higher risk of death in patients with a specific type of heart attack.

## Contribution

EFT ≥ 5.45 mm is shown to be a reliable non-invasive predictor of CAD severity and mortality risk in STEMI patients.

## Key findings

- EFT was significantly correlated with CAD severity, thrombus burden, and mortality risk.
- An EFT cutoff of 5.45 mm effectively predicted moderate/high CAD severity and 6-month MACE.
- EFT independently predicted high mortality risk in multivariable analysis.

## Abstract

Epicardial adipose tissue has been identified as a significant marker in the assessment of coronary artery disease (CAD), with a possible impact on the development of acute coronary events including ST-elevation myocardial infarction (STEMI).

To assess the association and predictability of echocardiographic-measured epicardial fat thickness (EFT) for the severity of CAD and mortality risk among STEMI patients.

This study included 159 STEMI patients who underwent primary percutaneous coronary intervention (PPCI) and survived the in-hospital duration. Anthropometric measurements, lipid profiles, and angiographic data were recorded. The correlations between echo-measured EFT and CAD severity indicated by the syntax score (SS) were assessed. In-hospital and 6-month major adverse cardiovascular events (MACE) were reported, and mortality risk was evaluated using the Grace score.

Among the study population, 104 patients (65.4%) had low SS, 45 patients (28.3%) had moderate SS, and 10 patients (6.3%) had high SS. STEMI patients with moderate/high SS had significantly larger EFT. EFT showed a significant correlation with BMI (r = 0.57), fat mass (kg) (r = 0.44), LDL (r = 0.40), the syntax score (r = 0.74), and the Grace score (r = 0.68), (p < 0.001 for all). Our ROC-derived cutoff value of EFT ≥ 5.45 mm significantly discriminated STEMI patients with moderate/high-SS, high coronary thrombus burden, 6-months high mortality risk, and 6-months MACE with reasonable respective sensitivity and specificity. Increased EFT independently predicted moderate/high-SS and high mortality risk on multivariable regression analysis.

Echo-measured EFT ≥ 5.45 mm might be a reliable non-invasive marker for predicting CAD severity, high coronary thrombus burden, 6-months high mortality risk, and 6-months MACE among STEMI patients.

The online version contains supplementary material available at 10.1186/s44156-025-00087-y.

Echo-derived EFT is a reliable and versatile tool for risk assessment among STEMI patients.STEMI patients with moderate/high SS had significantly larger EFT and PFT.EFT ≥ 5.45 mm significantly discriminated STEMI patients with moderate/high-SS.EFT ≥ 5.45 mm predicted high thrombus burden, 6-months high mortality risk, and 6-months MACE.EFT might be incorporated in risk models for 1ry and 2ry prevention of CAD.

Echo-derived EFT is a reliable and versatile tool for risk assessment among STEMI patients.

STEMI patients with moderate/high SS had significantly larger EFT and PFT.

EFT ≥ 5.45 mm significantly discriminated STEMI patients with moderate/high-SS.

EFT ≥ 5.45 mm predicted high thrombus burden, 6-months high mortality risk, and 6-months MACE.

EFT might be incorporated in risk models for 1ry and 2ry prevention of CAD.

The online version contains supplementary material available at 10.1186/s44156-025-00087-y.