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The Reliability and Prognosis of In-Hospital Diagnosis of Metabolic Syndrome in the Setting of Acute Myocardial Infarction
Study Questions:
What is the reliability and prognosis of an in-hospital diagnosis of metabolic syndrome (MetS) following acute myocardial infarction (AMI)?
Methods:
This was an observational study of patients participating in the TRIUMPH (Translational Research Investigating Underlying disparities in acute Myocardial infarction Patients’ Health status) prospective cohort study. Patients were categorized into four groups: 1) no MetS baseline and 1-month (MetS-/MetS-); 2) MetS baseline and no MetS 1-month (MetS+/MetS-); 3) no MetS baseline and MetS 1-month (MetS-/MetS+); and 4) MetS baseline and 1-month (MetS+/MetS+). Logistic regression evaluated the ability of baseline MetS diagnosis to predict follow-up MetS diagnosis. The combined endpoint of death or rehospitalization over 12 months was compared between groups.
Results:
Diagnostic criteria for MetS were met by 69% of patients during AMI hospitalization and 63% at 1-month follow-up. The sensitivity and specificity of MetS diagnosis at baseline for the diagnosis at 1 month were 87% and 61%, respectively. “True” metabolic syndrome patients (MetS-/MetS+) had the worst outcomes (mortality = 4.1%, rehospitalization = 36.2%), compared to MetS+/MetS- patients (mortality = 2.5%, rehospitalization = 33.7%) and MetS-/MetS- patients (mortality = 2.0%, rehospitalization = 25.6%).
Conclusions:
The diagnosis of MetS is very common following AMI, and can be made accurately. Patients identified as having MetS either at the time of AMI or 1 month have a poor prognosis. Those patients classified as having MetS following AMI, but not so at follow-up also have comparatively poorer outcomes.
Perspective:
MetS is an established risk factor for developing cardiovascular complications. While typically diagnosed in the ambulatory setting, there may be value to identifying patients with MetS prior to discharge following AMI, when patients may be most motivated to engage in risk factor modification. This study confirms that MetS is very common following an AMI and that it is associated with an adverse prognosis. Future studies should define whether an in-hospital identification of patients with MetS would modify outcomes following AMI.
Keywords: Dipeptides, Metabolic Syndrome, Prognosis, Neuropeptide Y, Myocardial Infarction, Follow-Up Studies, Cardiovascular Diseases, Translational Medical Research, Risk Factors, Health Status, Logistic Models
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