The Relationship Between Trimethylamine N-Oxide and Coronary Collateral Circulation in Patients with ST-Segment Elevation Myocardial Infarction

Abstract

Background. Coronary collateral circulation (CCC) plays a significant role in protecting the myocardium from ischemia during the events of myocardial infarctions. Elevated trimethylamine n-oxide (TVFO) levels induce NLRP3 inflammasome activation and subsequently trigger inflammatory and immune responses which has been shown to be atherogenic. However, only a few research studies of limited scale have reported the relationship between increased TMAO levels and impaired CCC development. We aimed to investigate the association between serum TMAO levels and CCC in Causaasian STEMI patients. Methods. This is a prospective study of 400 STEMI patients who underwent primary percutaneous coronary intervention (PCI) between September 2020 and September 2021. Inclusion criteria were patients with STEMI submitted to primary angioplasty within 120 min after ECG diagnosis. Angiographic collateral flow was evaluted using the Rentrop collateral score (RCS), RCS-o indicates no visible coronary collaterals; RCS-1, coronary collaterals without IRA filling; RCS-2, coronary collaterals with partial IRA filling and RCS-3, collaterals with complete IRA filing. Results. Overall, mean age was 68±14,8 years with 40.2% females. The left anterior descending (LAD) artery was the most common culprit vessel, accounting for 61,1% of cases, followed by the right coronary artery (32.0%) and the left circumflex artery (6.9%). 320 patients (80%) had RCS0-1, whilst 80 (20%) had RCS 2-3. Pateints with RCS 2-3 were with higher level of TMAO younger that those without (55.8 vs 65.2, p<0.05) and had a longer ischemic time (403.7 mins vs 235.8 mins, p<0.0001). Moreover, they were more likely to have the RCA as the culpit vessel, compared with the LAD or LCx (40.8% vs11.2% vs 13.5%, p<0.0001). The presence of well-developed collaterals had a higher on-admission TMAO levels than those with poorer formed collaterals (20.2 uM vs 6uM, p<0.01), and wasw associated with a with a greater LVEF (530.7% vs 44.5%, p<0.0001). At one month follow up, the presence of well-developed collaterals was not associated with lower cardiovascular events or mortality rates. Based on the receiver operating characteristic (ROC) curve, the optimal cut off value of serum level of TMAO as an indicator for screaning of well-developed collaterals was estimated to be 7,1 pM, which yielded a sensitivity of 69.3% and a specificity of 79.0%, with the area under the curve at 0.750 (95% CI, o.687-0,812). Conclusion. In STEMI patients, elevated levels of TMAO are associated with well developed collateral circulation.