Key result
Metabolic syndrome is linked to ~61% higher post-AMI MACE only in patients with LDL-C ≥100.
Why the study?
The clinical outcome of acute myocardial infarction patients with metabolic syndrome has not been well examined.
Does the presence of metabolic syndrome worsen 12-month clinical outcomes in patients with acute myocardial infarction undergoing successful PCI?
Cohort (n=6,352)
Yes
Does the presence of metabolic syndrome worsen 12-month clinical outcomes in patients with acute myocardial infarction undergoing successful PCI?
Hazard Ratio: 1.284 (95% CI 0.894–1.843)
Absolute Event Rate: 8.8% vs 6.2%
p-value: p=0.176
Metabolic syndrome is an independent predictor of 12-month MACE in AMI patients with LDL-C ≥100 mg/dL undergoing successful PCI, but not in the overall AMI population.
May support risk stratification by metabolic syndrome in hypercholesterolemic AMI; leaves open need for prospective validation before clinical adoption.
BACKGROUND AND OBJECTIVES: Metabolic 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 METHODS: We 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%). RESULTS: In 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. CONCLUSION: MetS 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.
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Ji et al. (2013) conducted a cohort in Acute Myocardial Infarction (n=6,352). Metabolic syndrome vs. No metabolic syndrome was evaluated on 12-month major adverse cardiac events (MACE) (HR 1.284, 95% CI 0.894-1.843, p=0.176). While metabolic syndrome did not significantly increase 12-month major adverse cardiac events in the overall acute myocardial infarction population, it was an independent predictor of MACE (HR 1.607) in patients with LDL-C ≥100 mg/dL.
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