Retinal artery calibre correlates with the risk of cardiovascular events, and could serve as an inexpensive and reproducible biomarker for cardiovascular diseases. Recently, a non-invasive approach for retinal imaging with OCT angiography has been proposed to evaluate retinal blood vessel density.

The EYE-MI study prospectively included all consecutive patients admitted to our University Hospital for acute coronary syndrome (ACS) between October, 1st and December, 31st 2016. Patients with retinal diseases were excluded. Retinal OCT angiography was performed within 2 days after admission to assess inner retina vascular density (IRVD), based on blood flow.

Of 212 patients admitted for ACS, 173 were included. Age was 62±12 years and 79% were male. When compared with the higher tertiles of IVRD, patients with the lowest tertile were older, had more often hypertension, diabetes and previous renal failure. Strikingly, AHA and SCORE risks were higher. Moreover, patients in the lowest IRVD tertile had higher SYNTAX and GRACE scores, lower LVEF and a higher heart rate and systolic blood pressure, despite similar rates of beta-blockers and RAAS inhibitors. After multivariate analysis, only AHA risk score (OR (95% CI): 1.07 (1.04–1.10),) and LVEF (OR (95% CI): 0.95 (0.92–0.98)) were associated with the lowest retinal vascular density. The strong association between the AHA risk score and IRVD was confirmed by Pearson correlation coefficient (r=−0.48, P<0.001) (Fig. 1).

In patients admitted for ACS, IRVD measured by OCT angiography was strongly associated with cardiovascular risk and with impaired LVEF. These preliminary results could help to target a specific population at high risk for cardiovascular events.