Coronary atherosclerotic burden and trimethylamine N-oxide in non-ST-segment myocardial infarction patients: SZ-NSTEMI cohort

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Trimethylamine N-oxide (TMAO) is reported to accelerate atherosclerosis and adverse cardiac outcomes. Relationship between coronary atherosclerotic burden and TMAO has linked in stable coronary artery disease and ST-segment elevation myocardial infarction, but not in non-ST-segment elevation myocardial infarction (NSTEMI). Objective We examined an association of TMAO with coronary atherosclerosis burden in NSTEMI. Methods In this prospective cohort, two groups including NSTEMI (n = 73) and age-sex matched Healthy (n = 35) individuals were enrolled between 2019 and 2020. The number of diseased coronary vessels and clinical risk scores including SYNTAX and GENSINI were used to stratify coronary atherosclerotic burden. Fasting plasma TMAO was measured by isotope dilution high-performance liquid chromatography. Results The median plasma TMAO levels (0.59 mM; [interquartile range [IQR]: 0.43-0.78) versus (0.42 mM; IQR: 0.33-0.64) were significantly higher in NSTEMI group versus Healthy group, respectively (P = 0.006). Among the patients with NSTEMI group, the plasma TMAO levels were significantly higher in the multivessel disease (MVD) versus single vessel disease (P = 0.002), and intermediate-high risk (score³23) versus low risk (score < 23) of SYNTAX (P = 0.003) and GENSINI (P = 0.005). TMAO levels remained independently associated with MVD (odds ratio [OR]: 5.94, P = 0.005), and intermediate-high risk SYNTAX (OR: 3.61, P = 0.013) and GENSINI scores (OR: 4.60, P = 0.008) following traditional risk factors adjustment. Area under receiver operating characteristic curves (AUC) for TMAO also predicted MVD (AUC: 0.73, 95% confidence interval [Cl]: 0.60-0.86, P = 0.002), and intermediate-high SYNTAX score (AUC: 0.70, 95%Cl: 0.58-0.82, P = 0.003) and GENSINI score (AUC: 0.70, 95%Cl: 0.57-0.83, P = 0.005). Conclusions TMAO levels are independently associated with high coronary atherosclerotic burden in NSTEMI. Abstract Figure. Abstract