Metabolic Syndrome and Long-Term Cardiovascular Outcomes in NSTEMI With Unstable Angina

Apr 21, 2014
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Authors:
Kul S, Uyarel H, Gul M, et al.
Citation:
Nutr Metab Cardiovasc Dis 2014;24:176-182.
Summary By:
Debabrata Mukherjee, MD, FACC

Study Questions:

What is the impact of metabolic syndrome (MS) on long-term clinical outcomes in patients with pure non−ST-segment elevation myocardial infarction (NSTEMI) or unstable angina pectoris (USAP)?

Methods:

The investigators prospectively enrolled 310 consecutive NSTEMI/USAP patients (74 females; mean age, 59.3 ± 11.9 years). The study population was divided into two groups: MS(+) and MS(−). The clinical outcomes of the patients were followed for up to 3 years. A backward stepwise multivariate Cox regression analysis, which included variables with a p value <0.1, was performed to identify the independent predictors of long-term cardiovascular mortality.

Results:

Increased 3-year cardiovascular mortality and reinfarction were observed in the MS(+) group, as compared to the MS(−) group (15 vs. 3.4%, p = 0.001, and 22.2 vs. 8.3%, p = 0.001, respectively). Hospitalization rates for heart failure and stroke were not significantly different between the two groups on follow-up. By a Cox multivariate analysis, a significant association was noted between MS and the adjusted risk of 3-year cardiovascular mortality (odds ratio, 3.4; 95% confidence interval, 1.24-9.1; p = 0.02).

Conclusions:

The authors concluded that MS is associated with an increased risk of 3-year cardiovascular mortality and reinfarction in patients with NSTEMI/USAP.

Perspective:

This analysis suggests that in acute coronary syndrome (ACS) patients, those with MS were more likely to be female, have a history of percutaneous coronary intervention, and have a lower left ventricular ejection fraction and higher Thrombolysis in Myocardial Infarction (TIMI) score, but in-hospital cardiac outcomes were not statistically different between the MS(+) and MS(−) groups. However, in the MS(+) patients, cardiovascular mortality and reinfarction were significantly more common in the follow-up period, and MS was independently associated with long-term cardiovascular mortality. Since the MS has a negative long-term impact on cardiovascular mortality and reinfarction in patients with ACS, it can be used as a marker of cardiovascular mortality in patients with ACS and aggressively targeted.

Keywords: Stroke, Acute Coronary Syndrome, Myocardial Infarction, Multivariate Analysis, Ventricular Function, Left, Percutaneous Coronary Intervention, Metabolic Syndrome, Heart Failure, Cardiovascular Diseases, Stroke Volume, Confidence Intervals, Hospitalization


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