The value of retinal microvascular features in predicting risk stratification and long-term prognosis of patients with acute coronary syndrome

This study investigates the retinal blood flow characteristics in patients with acute coronary syndrome (ACS) utilising Optical Coherence Tomography Angiography (OCTA) and Optical Coherence Tomography (OCT). It aims to correlate these characteristics with Grace risk stratification and long-term major adverse cardiovascular events (MACEs), while also examining the relationship between microvascular changes, risk stratification, and long-term prognosis in ACS patients. 122 ACS patients (122 eyes) underwent coronary angiography and percutaneous coronary intervention(PCI), with a follow-up period of 12 months. Patients were categorised into high-risk, intermediate-risk, and low-risk groups based on the Grace score. OCT was employed to assess the thickness of the full thickness, superficial layer, deep layer, outer layer, and optic nerve layer of the retina. The superficial, deep foveal, and parafoveal blood flow densities, along with the perimeter(PERIM), area, and the vessel density of the full retina in a width of 300 μm around the FAZ (FAD-300), were assessed using OCTA. Statistical differences were seen in inner retinal thickness and nerve fiber layer thickness throughout the superior, inferior, temporal, and nasal regions among the three groups. In the FAZ region, PERIM and FD-300 exhibited notable disparities across the three groups, whereas the FAZ area did not demonstrate significant variances. In superficial capillary plexus (SCP), the superior, inferior, temporal, and nasal regions of the parafovea exhibited substantial variations across the three groups, although no discernible abnormalities were seen in the foveal center. Substantial statistical differences were seen in the foveal center and the superior, inferior, temporal, and nasal regions of the parafovea for deep capillary plexus (DCP). Furthermore, the disparities between the medium-risk and high-risk groups were more pronounced than those between the low-risk and medium-risk groups. Subsequent multivariate logistic regression analysis indicated that FD-300 (OR, 1.642; 95% CI, 1.099–2.454; p = 0.016) and inner retinal thickness (OR, 1.949; 95% CI, 1.234–3.078; p = 0.004) were identified as risk variables for the incidence of MACEs. OCT and OCTA serve as rapid and reproducible non-invasive biomarkers, demonstrating potential for evaluating risk characteristics and adverse outcomes in patients with ACS. This facilitates advancements in the early detection, intervention, and treatment of cardiovascular diseases.