The eye-mi study: a prospective acute coronary syndrome cohort evaluated by retinal optical coherence tomography angiography
Résumé
Background: Microvascular abnormalities have been demonstrated to play a key role in the development of coronary artery disease. Retinal artery calibre has been shown to correlate with the risk of cardiovascular events, and could serve as an inexpensive and reproducible biomarker for cardiovascular diseases. Recently, a new approach for retinal imaging with OCT angiography has been proposed to evaluate retinal blood vessel density (based on blood flow) without intravenous injection. Methods: The EYE-MI study prospectively included all consecutive patients admitted to our University Hospital for acute coronary syndrome (ACS) between October, 1st and December, 31 2016. Retinal OCT angiography was performed in every patient within 2 days after the ACS. Inner retina vascular density was measured with the proprietary software of the machine. The population was divided into tertiles according to OCT angiography data, and bivariate and multivariate analyses were performed. Patients with retinal diseases were excluded. Results: Of 212 patients, 173 were retained for analysis. The mean age of the population was 62±12 years and 79% were male. When compared with the other two tertiles for inner vascular density, patients with the lowest inner vascular density (first tertile) were more likely to be older and to have systemic hypertension, diabetes and previous renal failure at admission. Moreover, both the AHA risk score and the SCORE risk were significantly higher in these patients. Regarding ACS parameters, patients in the lowest retinal vascular density tertile had higher SYNTAX and GRACE scores, lower LVEF and a higher heart rate and systolic blood pressure despite similar rates of prescription and doses of beta-blockers and RAAS inhibitors. After multivariate analysis, only the AHA risk score (OR (95% CI): 1.07 (1.04–1.10), p<0.001) and LVEF (OR (95% CI): 0.95 (0.92–0.98), p=0.002) were significantly and independently associated with the lowest tertile of retinal vascular density measured by OCT angiography. The strong association between the AHA risk score and vascular density was confirmed by a significant Pearson correlation coefficient, (R= -0.48, p<0.001).