![]() Recent reports have highlighted the involvement of gut microbes in the pathogenesis of both related adverse thrombotic events and atherosclerotic heart disease 8, 9, 10, 11, 12. Since awareness increased markedly regarding the involvement of gut microbes in the development of numerous cardiometabolic disease 5, 6, 7. Dating and predicting these events constitutes a clinical challenge. However, although mechanical reperfusion by percutaneous coronary intervention has reduced the acute mortality rates of MI, the incidence of post-MI cardiovascular events is still high and still predicts increased mortality 4. Strategies for preventing recurrent MI include suppression of inflammatory response, lipid level reduction, and regulation of multiple suppressive pathways to protect against adverse remodeling 4. Myocardial infarction (MI) is a frequent cause of heart failure and cardiac death worldwide 1, accounting for about 18 million deaths annually, or about 30% of all deaths globally 2, 3. The specific gut microbial taxa identified in association with serum TMAO levels may be potential predictive biomarkers for accurate diagnosis of ACS onset. ACS and incident post-STEMI MACE may be associated with the gut bacteria choline metabolite TMAO. Serum interleukin-6 levels were not significantly increased in patients with ACS and post-STEMI MACE. Risk stratification for incident major adverse cardiovascular events (MACE) improved at one year in patients with serum TMAO levels ≦2.19 µM. Elevated serum TMAO levels correlated independently with ACS (P < 0.05). Eubacterium_fissicatena, and decreased abundance of Lachnospiraceae_FCS020 (P < 0.05). Serum TMAO levels were positively associated with increased abundance of Aerococcaceae, Ruminococcaceae_UCG.005, Ruminococcaceae_UCC.014 and X. Minimal discriminators of gut microbial taxa (top 40) distinguished ACS patients from controls. Metagenomic sequencing was performed and TMAO and IL-6 were detected. A total of 60 patients, including 30 with unstable angina pectoris (UAP), 30 post-STEMI and 30 healthy controls, were enrolled from June to November 2017. We investigated associations between gut microbial taxa and systemic TMAO levels and the possible TMAO contribution to incident post-STEMI cardiovascular events. Plasma trimethylamine N-oxide (TMAO) is associated with coronary atherosclerotic plaque and cardiovascular disease risk, but associations between gut microbes in acute coronary syndrome (ACS) and post-ST-segment elevation myocardial infarction (post-STEMI) events are unknown.
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