Relation of Circulating Trimethylamine N-Oxide With Coronary Atherosclerotic Burden in Patients With ST-segment Elevation Myocardial Infarction

Abstract

The gut microbial metabolite trimethylamine N-oxide (TMAO) promotes atherosclerosis and cardiovascular diseases. TMAO levels are associated with the coronary atherosclerotic burden in patients with stable coronary artery disease. However, the relation between TMAO levels and the coronary atherosclerotic burden in patients with ST-segment elevation myocardial infarction (STEMI) is unknown. We prospectively enrolled 2 cohorts in this study, including 335 patients with STEMI and 53 healthy controls. The coronary atherosclerotic burden was quantified by the number of diseased coronary arteries and the SYNTAX score. The median TMAO levels in patients with STEMI and healthy controls were 2.18 (interquartile range [IQR]: 1.34 to 3.90) μM and 1.23 [IQR: 0.84 to 2.42] μM, respectively. Of the 335 patients with STEMI, TMAO levels were significantly higher in the multivessel disease group than in the single-vessel disease group (p <0.001) and in the group with intermediate-high SYNTAX scores (SYNTAX score ≥23) than in the group with low SYNTAX scores (SYNTAX score ≤22; p <0.001). Based on the ordinal logistic regression analysis adjusted for traditional risk factors, elevated TMAO levels predicted both a high SYNTAX score (adjusted odds ratio [OR]: 1.16; 95% confidence interval [CI] 1.06 to 1.29; p = 0.001) and the presence of multivessel disease (adjusted OR: 1.15; 95% CI 1.01 to 1.32; p = 0.035). In conclusion, plasma TMAO levels are associated with a high coronary atherosclerotic burden in patients with STEMI.