Association between the Changes in Trimethylamine N-Oxide-Related Metabolites and Prognosis of Patients with Acute Myocardial Infarction: A Prospective Study

Figures

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  Figure 1. Kaplan—curve for cumulative event-free survival in groups stratified by TMAO tertile levels at enrollment. (A) major adverse cardiovascular event, (B) all-cause death, (C) myocardial infarction, (D) rehospitalization caused by heart failure; (E) stroke; (F) revascularization. TMAO, trimethylamine-N-oxide.

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  Figure 2. Forest plot of hazard ratios for major adverse cardiovascular events in groups according to trimethylamine N-oxide (TMAO) (A,B) and choline (C,D) levels at enrollment (V1) and follow-up visit (V2). Patients with available TMAO and choline levels of V1 and V2 were divided into four groups according to the median levels of each visit (TMAO: 6.7 µmol/L and 12.7 µmol/L, choline: 1.2 µmol/L and 1.7 µmol/L for V1 and V2, respectively). L/L, low V1 and low V2; L/H, low V1 and high V2; H/L, high V1 and low V2; H/H, high V1 and high V2. Cox proportional hazards regression was used to compare the risk of major adverse cardiovascular events among the four groups of patients using L/L as the reference on each occasion [(A,C) unadjusted, (B) adjusted with age, hypertension, diabetes, peripheral artery disease, chronic kidney disease, and previous history of stroke and MI, Killip II-IV, the Global Registry of Acute Coronary Events risk score, multiple vessels disease, percutaneous coronary intervention, and the peak value of cardiac troponin I and N-terminal pro-B-type natriuretic peptide during hospitalization, as well as estimated glomerular filtration rate and left ventricular ejection…

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  Figure 3. Decision tree of risk stratification for major adverse cardiovascular events (MACE) using combined measurements at enrollment (V1) and follow-up visit (V2) for trimethylamine N-oxide (TMAO) (A). Kaplan–Meier curve for cumulative MACE-free survival in groups generated by decision tree (B). Decision tree using plasma TMAO level at V1 as the initial classifier, followed by plasma TMAO level at V2 enables effective selection of low- and high-risk groups of patients and increased cumulative event risk in Group 3 compared to Group 1. The number of events is shown below. Data are presented as adjusted hazard ratio (HR) and 95% confidence interval (CI). The adjusted factors included age, hypertension, diabetes, peripheral artery disease, chronic kidney disease, previous history of stroke and MI, Killip II-IV, the Global Registry of Acute Coronary Events risk score, multiple vessels disease, percutaneous coronary intervention, and the peak value of cardiac troponin I and N-terminal pro-B-type natriuretic peptide during hospitalization, as well as estimated glomerular filtration rate and left ventricular ejection fraction at V2.