Associations Between Metabolic Syndrome and Long-Term Mortality in Patients who underwent Percutaneous Coronary
Joseph M O'Brien1, Diem Dinh2, Louise Roberts1
1Department of Cardiology, Eastern Health, Box Hill, Victoria, Australia.
Insights
Metabolic syndrome (MetS) affects one in three patients undergoing percutaneous coronary intervention (PCI). While associated with higher mortality initially, MetS is not an independent predictor of long-term outcomes after PCI.
Area of Science:
- Cardiovascular Medicine
- Metabolic Disorders
- Interventional Cardiology
Background:
- Metabolic syndrome (MetS) significantly increases coronary heart disease risk.
- Long-term prognosis following percutaneous coronary intervention (PCI) in MetS patients remains understudied.
- Understanding MetS impact on PCI outcomes is crucial for patient management.
Purpose of the Study:
- To assess the prevalence of MetS in an Australian PCI cohort.
- To compare 30-day outcomes and long-term mortality between patients with and without MetS post-PCI.
- To evaluate MetS as an independent predictor of long-term mortality after PCI.
Main Methods:
- Retrospective analysis of the Melbourne Interventional Group multicenter PCI registry (n=41,146).
- Modified MetS definition: ≥3 of hypertension, diabetes mellitus, dyslipidemia, or BMI ≥30 kg/m².
- Cox regression analysis for multivariable effect of MetS on long-term mortality.
Main Results:
- MetS prevalence was 34% (12,228 patients).
- MetS patients had higher 30-day myocardial infarction rates (2.2% vs 1.8%).
- Long-term mortality was higher in MetS patients (24% vs 19%), but MetS was not an independent predictor after adjustment (HR 0.95, p=0.35).
- MetS-Diabetic patients had highest mortality; MetS-NonDiabetic obese patients had lowest.
- Diabetes mellitus strongly associated with long-term mortality.
Conclusions:
- MetS is common in PCI patients and associated with worse short-term outcomes and higher crude long-term mortality.
- After adjusting for confounders, MetS is a marker rather than an independent predictor of long-term mortality post-PCI.
- Findings support the obesity paradox and highlight the significant impact of diabetes mellitus on long-term PCI outcomes.
Abstract:
Metabolic syndrome (MetS) provides significant risk for coronary disease, however long-term prognosis after percutaneous coronary intervention (PCI) has been understudied. We assessed the prevalence and outcomes of patients with MetS from an Australian PCI cohort. We retrospectively examined data from the Melbourne Interventional Group multicenter PCI registry using a modified definition for MetS including ≥3 of the following: hypertension, diabetes mellitus, dyslipidemia, and body mass index ≥30 kg/m2. Thirty-day outcomes and long-term mortality were compared with patients without MetS. Cox regression methods were used to assess the multivariable effect of MetS on long-term mortality. Of 41,146 patients, 12,228 (34%) had MetS. Patients with MetS experienced greater 30-day myocardial infarction (2.2% vs 1.8%, p = 0.013), whereas patients without MetS had a trend for greater 30-day mortality (3.0% vs 3.4%, p = 0.051) and greater in-hospital major bleeding (1.7% vs 2.4%, p <0.001). After a median follow-up of 5.62 years (Q1 2.03, Q3 8.89), patients with MetS experienced greater mortality (24% vs 19%, p <0.001). After adjustment, MetS was not an independent predictor of long-term mortality (hazard ratio 0.95 confidence interval 0.86 to 1.05, p = 0.35). In sensitivity analyses, MetS-Diabetic patients had the highest, and MetS-NonDiabetic obese patients had the lowest long-term mortality. One in 3 patients who underwent all-comer PCI presented with MetS and experienced greater long-term mortality compared with others. However, this association was lost after adjustment for baseline confounders, highlighting that MetS is a marker of risk after PCI. Our findings support the obesity paradox and confirm robust associations between diabetes mellitus and long-term mortality.
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