Epicardial Adipose Tissue Thickness and Body Mass Index as Early Predictors of Thrombolysis Success in Patients with Elevated ST-Segment Myocardial Infarct

 Early intravenous thrombolysis in elevated ST-segment myocardial infarcted patients reduces morbidity/mortality, however in non-responsive patients, it can delay the endovascular revascularization process. Increased epicardial adipose tissue thickness (EATT) is associated with adverse cardiovascular events and artery patency. Our aim was to evaluate if EATT influences the response to thrombolytic therapy in patients with acute myocardial infarction. This prospective cohort study included fifty patients (40 males and 10 females) with a mean age of 60 ± 9 years old and a presumptive acute myocardial infarct diagnosis. All the patients were hospitalized in the intensive care coronary unit. According to ESC and ACC guidelines, the diagnosis of acute myocardial infarct was corroborated. Patients were treated with 0.5 mg/kg IV bolus of the specific recombinant plasminogen activator Tenecteplase. The transthoracic 2-dimensional echocardiography was performed to recognize EAT from the parasternal long-axis view. The time lapse between initial symptoms and thrombolysis was 227±43 mm. Sixteen patients showed positive reperfusion less than 90 minutes after thrombolysis, and the remaining 34 required a percutaneous coronary intervention. The mean EATT value of thrombolysis-responding patients was 2.4 ± 0.4 mm vs 6.5 ± 0.6 mm of the non-responders (p= 0.001). In responders, the percentage of  body mass index  (BMI)  was 26.1 ± 0.02% vs 29.1± 0.02% (kg/m2)  in non-responders (p= 0.001). Interestingly, an EATT value > 2.5 mm and a BMI > 26 showed a highly significant inverse correlation response to thrombolysis and positive myocardial reperfusion (r = -0.71 y 0.55, p = 0.001 respectively). These values had a prognostic sensitivity of 93% and specificity of 84%. EATT and BMI could be usefull serve as early decision indicators to determine the possible response to thrombolysis and positive myocardial reperfusion in acute myocardial infarcted patients, although there is a need for studies with larger sample sizes.