Table III.
Reported Studies of the MetS and ACS
| Author, Year (Origin) | Study Design | No. of Patients | Previous DM, % | Previous MetS Definition, % | Follow‐Up | Outcome |
|---|---|---|---|---|---|---|
| Boulon, 2006 (France) 2 | Registry | 480 | 21.6 | ATP III: 20.8; IDF: 27.7 | 19 mo | Increase in total mortality in the MetS group (5.2% vs 1.4%, P<.01) due in part to an increase in noncardiovascular death. No increase in minor or major cardiovascular events. |
| Zeller, 2005 (France) 3 | Registry | 633 | 26 | ATP III: 46 | In‐hospital | Independent predictor of heart failure (OR, 2.13; 95% CI, 1.28–3.57; P=.003) but not death. |
| Clavijo, 2006 (United States) 4 | Registry | 405a | b | ATP III: 41b | In‐hospital | Associated with larger infarct size determined by cardiac enzymes (P<.001), more complications (21.1% vs 9.2%, P=.003), and a marked increase of acute renal failure (7.9% vs 0.8%, P=.007). |
| Celik, 2006 (Turkey) 5 | Registry | 283a | b | ATP III: 25 | In‐hospital | Independent predictor of poor myocardial perfusion grade post‐primary PCI (OR, 2.54; 95% CI, 1.35–4.75; P=.003). |
| Chung, 2007 (United States)6 | Registry | 223c | 13 | ATP III: 47 | Not provided | MetS highly prevalent in young (≤45 y) with MI. |
| Milionis, 2007 (Greece) 7 | Registry | 136c | 2.2 | ATP III: 40.4 | In‐hospital | MetS strongly associated with ACS in young persons, independent of other risk factors. Smoking and a positive family history of premature CAD in young persons with MetS had an incremental effect on the odds of having ACS (OR, 7.12; 95% CI, 2.42–20.96; P<.001). |
| Prasad, 2009 (Australia) 8 | Registry | 107a | 19 | IDF: 54 ATP III: 49 | In‐hospital | Same extent of coronary atherosclerosis and coronary flow post‐PCI. No differences in systolic function but greater diastolic dysfunction with MetS (P<.05). |
| Tokeno, 2008 (Japan) 9 | Registry | 461a | 34 | ATP III: 37 | 17.6 mo | Independent predictor of heart failure (OR, 2.60; 95% CI, 1.01–6.66; P=.04) and repeat revascularization (OR, 2.1; 95% CI, 1.27–3.47; P<.01). |
| Yasar, 2009 (Turkey) 10 | Registry | 116 | 27 | ATP III: 55.2 | In‐hospital | MetS patients have lower rates of TIMI grade 3 flow (OR, 3.545; 95% CI, 1.064–11.808; P=.03) and higher corrected TIMI frame counts after thrombolytic therapy for AMI. |
| Koutsovasilis, 2009 (Greece) 11 | Registry | 211 | 30.3 | ATP III: 72.5 NHLBI/AHA: 81.2 IDF: 79.1 | Compared with control | Only IDF‐defined MetS was significantly associated with ACS (OR, 2.23; 95% CI, 1.3–3.82; P=.003). Of the MetS components, only waist circumference was independently associated with ACS (OR, 1.045; 95% CI, 1.014–1.078; P=.005). |
| Dohi, 2009 (Japan) 12 | Registry | 384 (with complete revascularization) | ATP III: 42.5 | 10.4±3.4 y | Independent predictor of long‐term all‐cause (OR, 1.62; 95% CI, 1.01–2.59; P=.046) and cardiovascular death (OR, 2.40; 95% CI, 1.16–4.94; P=.018). | |
| Levantesi, 2005 (Italy)d 13 | RCT‐post hoc (GISSI‐Prevenzione) | 10,384 | 20.6 | ATP III: 29.3 | 3.5 y | Increased probability of death (OR, 1.29; 95% CI, 1.1–1.51; P=.002) and cardiovascular events (OR, 1.23; 95% CI, 1.06–1.42; P=.005) at follow‐up; however, hospitalization for heart failure at follow‐up was not increased. |
| Germain, 2004 (Europe‐United States)e 14 | RCT‐post hoc (4S and AFCAPS/TexCAPS) | 5179 (not all with prior ACS) | b | ATP III: 20.6–46 | 5–5.4 y | 4S: Independent predictor of major adverse cardiac events (OR, 1.5; 95% CI, 1.2–1.8). AFCAPS/TexCAPS: Independent predictor of major adverse cardiac events (OR, 1.4; 95% CI, 1.04–1.9). |
| Schwatrz, 2005 (United States) 15 | RCT‐Post hoc (MIRACL) | 3083 | 23 | ATP III: 38 | 16 wk | Independent predictor of major adverse cardiac events at 16‐week follow‐up (OR, 1.49; 95% CI, 1.24–1.79; P<.0001). Independent predictor of all‐cause mortality (OR, 1.49; 95% CI, 1.04–2.14; P=.029). |
| Current study (6 Middle Eastern countries) | Registry | 6701 | 40 | New unified: 46 | In‐hospital | Increased risk of heart failure and recurrent myocardial ischemia but not death. STEMI patients have double the risk of recurrent myocardial infarction and stroke. |
Abbreviations: ACS, acute coronary syndrome; ATP III, National Cholesterol Education Program Adult Treatment Panel III; CI, confidence interval; DM, diabetes mellitus; IDF, International Diabetes Federation; MIRACL, the Myocardial Ischemia Reduction With Aggressive Cholesterol Lowering trial; OR, odds ratio; PCI, percutaneous coronary intervention; RCT, randomized controlled trial; STEMI, ST‐elevation myocardial infarction; TIMI, thrombolysis in myocardial infarction. aAcute myocardial infarction (AMI) patients only. bNondiabetic with metabolic syndrome (MetS). cThe study included only patients younger than 45 years. dPost hoc analysis of randomized trial (the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico [GISSI‐Prevenzione] Trial), which included patients who had a recent MI (within 3 months). ePost hoc analysis of two randomized trials (the Scandinavian Simvastatin Survival Study [4S] and the Air Force/Texas Coronary Atherosclerosis Prevention Study [AFCAPS/TexCAPS]).