Key result
Elevated TMAO linked to ~494% higher odds of multivessel disease in NSTEMI patients.
Why the study?
The relationship between coronary atherosclerotic burden and trimethylamine N-oxide (TMAO) has not been examined in non-ST-segment elevation myocardial infarction (NSTEMI) patients.
Is fasting plasma TMAO associated with coronary atherosclerotic burden in patients with NSTEMI?
Cohort (n=108)
Is fasting plasma TMAO associated with coronary atherosclerotic burden in patients with NSTEMI?
Odds Ratio: 5.94
p-value: p=0.005
Elevated fasting plasma TMAO levels are independently associated with a higher coronary atherosclerotic burden, including multivessel disease and higher SYNTAX/GENSINI scores, in patients with NSTEMI.
Hypothesis-generating for TMAO in NSTEMI risk stratification; prospective validation required before clinical use.
Trimethylamine N-oxide (TMAO) is reported to accelerate atherosclerosis and the development of adverse cardiac outcomes. Relationship between coronary atherosclerotic burden and TMAO has been examined in stable coronary artery disease and ST-segment elevation myocardial infarction, but not in non-ST-segment elevation myocardial infarction (NSTEMI). We examined the association between TMAO and coronary atherosclerotic burden in NSTEMI. In this prospective cohort study, two groups including NSTEMI (n = 73) and age-sex matched Healthy (n = 35) individuals were enrolled between 2019 and 2020. Coronary atherosclerotic burden was stratified based on the number of diseased coronary vessels and clinical risk scores including SYNTAX and GENSINI. Fasting plasma TMAO was measured by isotope dilution high-performance liquid chromatography. The median plasma TMAO levels were significantly higher in the NSTEMI group than in the Healthy group, respectively (0.59 μM; interquartile range [IQR]: 0.43-0.78 versus 0.42 μM; IQR: 0.33-0.64; P = 0.006). Within the NSTEMI group, higher TMAO levels were observed in the multivessel disease (MVD) versus single vessel disease (P = 0.002), and intermediate-high risk (score ≥ 23) versus low risk (score < 23) of SYNTAX (P = 0.003) and GENSINI (P = 0.005). TMAO level remained an independent predictor of MVD (odds ratio [OR]: 5.94, P = 0.005), intermediate-high risk SYNTAX (OR: 3.61, P = 0.013) and GENSINI scores (OR: 4.60, P = 0.008) following adjustment for traditional risk factors. Receiver operating characteristic curve (AUC) analysis for TMAO predicted MVD (AUC: 0.73, 95% confidence interval [Cl]: 0.60-0.86, P = 0.002), 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). In all, TMAO levels are independently associated with high coronary atherosclerotic burden in NSTEMI.
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Waleed et al. (2021) conducted a cohort in Non-ST-segment elevation myocardial infarction (NSTEMI) (n=108). Trimethylamine N-oxide (TMAO) vs. Healthy individuals / lower TMAO levels was evaluated on Multivessel disease (MVD) (OR 5.94, p=0.005). Elevated fasting plasma TMAO levels were independently associated with multivessel disease (OR 5.94, P=0.005) and higher coronary atherosclerotic burden in patients with NSTEMI.