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

Purpose This study investigates the retinal blood flow characteristics in patients with acute coronary syndrome (ACS) utilising OCTA and OCT. It aims to correlate these characteristics with Grace risk stratification and long-term major adverse cardiovascular events (MACE), while also examining the relationship between microvascular changes, risk stratification, and long-term prognosis in ACS patients. Method 122 ACS patients (122 eyes) underwent coronary angiography and 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, area, and FAD-300 of the FAZ, were assessed using OCTA. Result Grace staging has a negative correlation with the macular foveal and parafoveal SCP and DCP, achieving statistical significance. In the FAZ region, statistical disparities were seen in PERIM and FD among various groups; however, no significant difference was identified in the FAZ area. The thickness of the inner retina and the nerve fibre layer correlates with Grace stage. Ordinal logistic regression analysis reveals that FD-300, foveal DCP, inner retinal thickness, and nerve fibre layer thickness are strongly correlated with Grace high-risk staging (r=-0.761, P = 0.024)(r=-0.510, P = 0.035)(r=-0.895, P = 0.029)(r=-0.371, P = 0.035). Comparative analysis of the aforementioned indicators between the 18 persons who suffered MACE episodes and the 23 high-risk individuals without MACE events revealed statistically significant differences. Conclusion 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.