Prognostic Value of Metabolic Syndrome in Patients With Non-ST Elevated Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Abstract

Objective: We aim to investigate the prognostic effects of metabolic syndrome (MS) on patients with non-ST elevated myocardial infarction (NSTEMI) after percutaneous coronary intervention (PCI).

Methods: Patients with NSTEMI undergoing PCI were consecutively collected. According to the presence or absence of MS, they were divided into two groups and followed up for 1 year. The endpoint was major adverse cardiovascular events (MACE), including all-cause death, unstable angina hospitalization, heart failure (HF) hospitalization, non-fatal recurrent myocardial infarction (MI), and target lesion revascularization. Also, six subgroups were made according to gender, age, left ventricular ejection fraction (LVEF), Global Registry of Acute Coronary Events (GRACE) score, hypersensitive troponin (hsTNT), and several diseased vessels. Cox proportional hazard model was adopted to analyze the effect of MS on MACE in all the patients and different subgroups.

Results: A total of 1,295 patients were included in the current analysis and 660 (50.97%) of them had MS. About 88 patients were lost to follow-up, and the overall average follow-up was 315 days. MS was an independent risk factor for MACE (HR 1.714, CI 1.265-2.322, p = 0.001), all-cause death, heart failure (HF) hospitalization, and non-fatal recurrent MI. In the MS component, BMI ≥28 kg/m² was positively associated with MACE. Subgroup analysis indicated the prognostic value of MS was more striking for patients with the following: age of >60, LVEF of ≤40%, GRACE of >140, multivessel disease, or hsTNT of >0.1 ng/ml.

Conclusions: The MS was a robust adverse prognostic factor in patients diagnosed with NSTEMI, especially among those of older age and at higher ischemic risk. A BMI of ≥28 kg/m² independently predicted the occurrence of MACE. Prognosis may be improved by controlling abdominal obesity.

Keywords: cohort study; metabolic syndrome; non-ST elevated myocardial infarction; percutaneous coronary intervention; prognostic value.

Figure 1

Kaplan-Meier survival analysis of cumulative event-free survival curves within 1 year according to MS. MS, metabolic syndrome.

Figure 2

Multivariate COX regression analysis of MACE. ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BMI, body mass index; CI, confidence interval; CVD, cardiovascular disease; HDL-C, high-density lipoprotein cholesterol; HR, hazard ratio; LVEF, left ventricular ejection fraction; MACE, major adverse cardiovascular events; MS, metabolic syndrome; MVD, multivessel disease.

Figure 3

Subgroup analysis of MS on MACE in different patients. This figure shows the adjusted HR (95% CI) of the subgroup analysis from the multivariable Cox model. (A–F) Represent the subgroups according to different gender, age, LVEF, GRACE, number of stenosis vessels, hsTNT. The red line denotes a statistically significant subgroup. CI, confidence interval; GRACE, Global Registry of Acute Coronary Events; hsTnT, hypersensitive troponin T; HR, hazard ratio; LVEF, left ventricular ejection fraction; MACE, major adverse cardiovascular events; MS, metabolic syndrome; MVD, multivessel disease; SVD, single-vessel disease.