Paper Title
Serum Asprosin As A Metabolic Imaging Biomarker of Plaque Vulnerability in STEMI

Abstract
Introduction Diabetes mellitus is associated with insulin resistance, systemic inflammation, accelerated atherosclerosis and higher plaque vulnerability in ST-elevation myocardial infarction. Asprosin, a fasting-induced adipokine involved in glucose metabolism and metabolic dysfunction, has emerged as a potential biomarker in coronary artery disease; however, its relationship with OCT-defined plaque vulnerability in STEMI remains inadequately explored. Aim To evaluate the association of serum asprosin levels with coronary artery disease severity, OCT-derived plaque vulnerability, inflammatory markers and short-term clinical outcomes in patients presenting with ST-elevation myocardial infarction. Methodology This prospective observational comparative study included 94 STEMI patients, comprising 47 diabetic and 47 non-diabetic individuals. Clinical profile, glycemic status, inflammatory markers, serum asprosin, adiponectin, coronary angiographic severity using SYNTAX score, OCT plaque parameters and in-hospital outcomes were assessed and compared between both groups. Results Diabetic STEMI patients had higher metabolic derangement and more severe coronary artery disease. Mean SYNTAX score was significantly higher among diabetic patients than non-diabetic patients (26.5 ± 10.3 vs 18.6 ± 8.1; p<0.001), while high SYNTAX score was more frequent in diabetics (23.4% vs 6.4%; p=0.019). OCT showed significantly lower minimum cap thickness in diabetics (52.6 ± 11.1 μm vs 58.1 ± 9.8 μm; p=0.010). Serum asprosin showed significant positive correlation with TCFA thickness, IL-6 and TNF-α, and negative correlation with adiponectin. Asprosin also correlated significantly with Gensini score, SYNTAX score, number of lesions and number of involved segments. Higher asprosin levels were observed in plaques with calcification, rupture, erosion, thrombus and cholesterol crystals. Diabetic patients had higher rates of heart failure and overall in-hospital complications. Conclusion Serum asprosin was significantly associated with coronary artery disease severity, inflammatory activity and vulnerable plaque morphology in STEMI patients. Integrated assessment using asprosin, OCT plaque characterization and angiographic scoring may improve risk stratification, particularly in diabetic STEMI patients. Keywords: STEMI; Asprosin; Diabetes Mellitus; Optical Coherence Tomography; Plaque Vulnerability