Effect of metabolic syndrome on prognosis of revascularization in patients with coronary artery disease

Abstract

Objective This study was conducted to assess the prevalence, characteristics, in-hospital and long term prognosis of coronary artery disease (CAD) with metabolic syndrome(MS), and to determine the factors that influencing the CAD prognosis most. Methods The DESIRE (drug-eluting stent impact on revascularization) registry represents a database of 2368 patients with CAD between July 2003 and September 2004. Median long-term follow-up was 3.5 years(293-1855 days). The diagnosis of MS was based on the modified Adult Treatment Panel (ATP) Ⅲ Definition of the MS in 2005, using body mass index (BMI) instead of waist circumference. We tested the ability of MS and its components in predicting the incidence of major adverse cardiac and cerebral events (MACCE) in a large cohort of patients undergoing revascularization. Results Presence of MACCE was predicted only by MS(adjusted odds ratio (OR)=1.319, 95%CI 1.020-1.706, P=0.035) but not other risk factors of cardiovascular (such as old age, male, smoking, high LDL cholesterol, CAD family history). MS was present in 45.6% (high FG 44.5%; high TG 45.0%; low HDL-C 50.8%; high BP 61.4%; high BMI 60.7%). After a follow-up of 3.5 ys, the ratio of MACCE in CAD patients with metabolic syndrome increased significantly (18.9%vs15.6%, P=0.036). In multivariable model of five factors of MS, MACCE was predicted by high FG(fasting glucose) (OR=1.047, 95%CI 1.005-1.091, P<0.05) and low HDL-C (OR=0.777, 95% CI 0.610-0.989, P<0.05). MS confers a higher risk of long-term MACCE in CAD patients with (OR=1.258, 95% CI 1.010-1.607, P<0.05)or without diabetes(OR=1.139, 95%CI 1.004-1.505, P<0.05). Conclusions MS has primary predictive ability for MACCE in CAD patients, carried primarily by high FG and low HDL. MS confers a higher risk of long-term MACCE in CAD patients with or without diabetes. Key words: Metabolic syndrome; Coronary artery disease; Prognosis