Prognostic significance and influencing factors of lipomatous metaplasia in patients after myocardial infarction

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OBJECTIVES: To investigate the prognostic value of lipomatous metaplasia (LM) in patients after myocardial infarction (MI) and to explore potential influencing factors of LM. MATERIALS AND METHODS: A total of 1702 (mean age 59.3 ± 10.27 years, 86.08% men) patients with a history of MI who underwent coronary CT angiography (CCTA) examinations were retrospectively enrolled. The clinical endpoints were major adverse cardiovascular events (MACE). A subgroup of 240 patients who underwent CCTA and cardiac magnetic resonance (CMR) examinations within a 14-day interval was analyzed to compare the prognostic values of LM and CMR parameters and to explore influencing factors of LM. RESULTS: MACE occurred in 395 (23.21%) patients during a median follow-up of 45.5 months. In the entire cohort, the prevalence of LM was 46.71% on CCTA; in the subgroup, it was 51.25% on CCTA and 21.67% on CMR. LM remained a significant outcome predictor (hazard ratio (HR) 1.39, 95% confidence interval (CI) 1.12-1.73; p = 0.002) in the multivariable model. In subgroup analysis, LM on CCTA (HR 1.83, 95% CI 1.09-3.08; p = 0.023) was a stronger outcome predictor than all CMR parameters. Revascularization history (odds ratio (OR) 2.833, p = 0.006), number of diseased coronary arteries (CA) (OR 0.556, p = 0.006) and infarct size (OR 1.094, p = 0.003) remained associated with LM in the multivariable model. CONCLUSION: LM was a significant outcome predictor in patients after MI and was stronger than CMR functional parameters and infarct size. Revascularization, infarct size and fewer diseased CA may be associated with LM development. CRITICAL RELEVANCE STATEMENT: Lipomatous metaplasia (LM) was a common complication following myocardial infarction (MI) that increased with infarct age, identifying LM and integration of LM assessment into risk stratification models for post-MI patients may be important for clinical strategy decisions. KEY POINTS: Lipomatous metaplasia was a common complication that increased with infarct age. Lipomatous metaplasia was a significant outcome predictor in patients after myocardial infarction, stronger than CMR functional parameters and infarct size. Revascularization procedure, infarct size and fewer number of diseased coronary arteries were associated with the presence of lipomatous metaplasia.

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