One-Year Clinical Outcomes among Patients with Metabolic Syndrome and Acute Myocardial Infarction

Abstract

Background and ObjectivesMetabolic syndrome (MetS) is an important risk factor for cardiovascular disease. However, the clinical outcome of acute myocardial infarction (AMI) with MetS has not been well examined. The purpose of this study was to evaluate the clinical outcomes of AMI patients with MetS.Subjects and MethodsWe evaluated a total of 6352 AMI patients who had successful percutaneous coronary interventions and could be identified for MetS between 2005 and 2008 at 51 hospitals participating in the Korea Acute Myocardial Infarction Registry. They were divided into 2 groups according to the presence of MetS: the MetS group (n=2493, 39.2%) versus the Non-MetS group (n=3859, 60.8%). In addition, 4049 AMI patients with high levels of low density lipoprotein-cholesterol (LDL-C) (≥100 mg/dL) among them, were divided into the MetS group (n=1561, 38.6%) versus the Non-MetS group (n=2488, 61.4%).ResultsIn the overall population, there was no significant difference in 12-month the major adverse cardiac events (MACE) rate between the 2 groups. However, the MetS group showed a significantly higher 12-month MACE rate in the high LDL-C population. Multivariate analysis showed that MetS was an independent prognostic factor for 12-month MACE {hazard ratio (HR) 1.607, 95% confidence interval (CI) 1.027 to 2.513, adjusted p=0.038} and for 12-month target vessel revascularization (HR 1.564, 95% CI 1.092 to 2.240, adjusted p=0.015) in the high LDL-C population.ConclusionMetS patients with AMI in the overall population showed no significant difference in 12-month clinical outcomes. However, in patients with higher LDL-C ≥100 mg/dL, they showed significantly worse clinical outcome than Non-MetS patients. Therefore, it is important to ascertain the presence of MetS in AMI patients, and more aggressive therapy should be strongly considered for AMI patient with MetS.

Comparison of Resolute zotarolimus-eluting stents versus everolimus-eluting stents in patients with metabolic syndrome and acute myocardial infarction

“…Studied patients were those implanted with first-generation DES (sirolimus-or paclitaxeleluting stent) or bare-metal stent in the studies by Xu D. et al, whereas our study investigated those treated with second-generation DES (EES or R-ZES). In addition, several studies including our previous study showed that MetS was a poor predictor of clinical outcome after coronary intervention in high risk patients, but not in the overall AMI population [26,27]. Thus, discrepancy in the results between our study and the previous studies might be attributed to the study population.…”

“…Moreover, Xu D. et al reported that MetS was a poor prognostic factor in patients treated with stent and even in patients treated with DES in a recent meta-analysis [8]. In addition, several studies including our previous study showed that MetS was a poor predictor of clinical outcome after coronary intervention in high risk patients [26,27].…”

“…Especially, De Luca et al reported the importance of shortening symptom-to-door time in AMI patients with "high-risk profile" [39], strongly supporting our finding. Additionally, considering that MetS patients are high-risk group and have many factors related to prolong symptom-to-treatment [27,40,41], this result might suggest the importance of minimizing symptom-to-door time in MetS patients. Finally, decreased renal function was another independent predictor of POCE, while there was a trend toward significance (p = 0.08) in predicting TLF, in agreement with previous studies [42][43][44].…”

Impaired Fasting Glucose Is the Major Determinant of the 20‐Year Mortality Risk Associated With Metabolic Syndrome in Nondiabetic Patients With Stable Coronary Artery Disease

“…To confound matters further, controversy exists about the assumption that MetS is useful in predicting mortality beyond its components 13, 14, 15. The prognostic importance of MetS compared with that of its individual components has repeatedly been challenged.…”

“…The prognostic importance of MetS compared with that of its individual components has repeatedly been challenged. Several studies argued that not all individual components of MetS contributed to the increased risk of all‐cause mortality 13, 14, 15. This risk was significantly predicted by impaired fasting glucose (IFG) in all subjects, as well as by IFG and low high‐density lipoprotein (HDL) cholesterol in women among an Italian population 18, 19, 20…”