title: Metabolic syndrome is associated with severe coronary artery disease and poor cardiac outcome in end-stage renal disease patients with acute coronary syndrome.
abstract: OBJECTIVE
  People with either end-stage renal disease or metabolic syndrome (MS) are at increased risk for developing coronary artery disease. The impact of MS on coronary artery disease in end-stage renal disease patients, however, remained unclear. We therefore evaluated whether the presence of MS is associated with more coronary lesions and a worse cardiac outcome in end-stage renal disease patients with acute coronary syndrome.
  
  
  METHODS
  We retrospectively examined 76 consecutive end-stage renal disease patients who experienced acute coronary syndrome and underwent cardiac catheterization. Cardiovascular events were compared between the MS and non-MS group.
  
  
  RESULTS
  MS was found in 58 patients and coronary artery disease was found in 63 patients [52 with MS (accounting for 90% of the MS group); 11 without MS (61% of the non-MS); MS vs. non-MS, P=0.01]. Patients with MS had more multi-vessel coronary artery disease (P<0.001) than those without MS. Sixty-nine (MS, 51; non-MS, 18) patients survived the acute coronary syndrome. During the follow-up period (MS, 17.6+/-13.8; non-MS, 19.9+/-11.7 months), 12 patients with MS (24%) and none without MS died owing to cardiovascular events (MS vs. non-MS, P=0.028). Regarding major cardiac events, including cardiac death, repeat non-fatal myocardial infarction, and repeat revascularization, the non-MS group had a higher probability of event-free survival (P<0.0001).
  
  
  CONCLUSIONS
  In patients with end-stage renal disease complicated by acute coronary syndrome, MS is frequently seen and associated with a higher probability of coronary artery disease involving multiple coronary branches and a higher probability of cardiac death and major cardiac events. Therefore, detection of MS in such patients is useful for risk stratification.
authors.affiliation: Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Han-Hsiang
authors.initials: HH
authors.lastname: Chen
authors.forename: Chih-Jen
authors.initials: CJ
authors.lastname: Wu
authors.forename: Yi-Chou
authors.initials: YC
authors.lastname: Chen
authors.forename: Chih-Sheng
authors.initials: CS
authors.lastname: Tsai
authors.forename: Fung-J
authors.initials: FJ
authors.lastname: Lin
authors.forename: Hung-I
authors.initials: HI
authors.lastname: Yeh
mesh_terms: D000368:Aged; D000787:Angina Pectoris; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000401:mortality; D052279:Creatine Kinase, MB Form / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology* / Q000401:mortality; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013577:Syndrome; D019210:Troponin I / Q000097:blood
chemical_list: D019210:Troponin I; D052279:Creatine Kinase, MB Form