Relationship between Epicardial Adipose Tissue Thickness Measured by Computed Tomography and Coronary Thrombus Burden in Patients with ST-elevation Myocardial Infarction

Background: Understanding the epicardial adipose tissue (EAT)–thrombus burden (TB) link in ST-segment elevation myocardial infarction (STEMI) may assist in singling out high-risk cases and guide therapies to reduce EAT or its activity, potentially improving outcomes. Aim: We aimed to study the EAT and coronary artery TB relationship in STEMI patients referred to primary percutaneous coronary intervention (PCI). Materials and Methods: This prospective observational study included 32 patients diagnosed with ST-elevation myocardial infarction (STEMI)و aged 18 years old or more, both sexes. All participants underwent primary percutaneous coronary intervention (PCI) within 12 hours of symptom onset and subsequently had a non-contrast cardiac computed tomography (CT) scan performed during their hospital stay to assess epicardial adipose tissue (EAT) thickness. Patients were assigned to two groups: relying on their angiographic thrombolysis in myocardial infarction (TIMI) thrombus grade: Group I: with low TB (Grades 0–3) and Group II: with high TB (Grades 4–5). Results: A strong positive correlation between EAT in the right atrioventricular (AV) groove and TIMI thrombus score (r = 0.624, P < 0.001), indicating that enhanced thickness of epicardial fat in this region is significantly associated with higher TB. Conversely, the correlation between EAT in the anterior interventricular groove and thrombus score was weaker, and statistical significance was not attained (r = 0.336, P = 0.060). Conclusions: Increased right AV groove EAT is strongly linked to higher TB in STEMI and may serve as a noninvasive CT predictor for thrombus risk.