title: Impact of the metabolic syndrome on the clinical outcomes of non-clinically diagnosed diabetic patients with acute coronary syndrome.
abstract: The aim of this study is to explore the impact of metabolic syndrome (MS) on the outcome of patients with non-clinically diagnosed diabetes with acute coronary syndrome (ACS) based on a comprehensive nationwide registry during a 1-year follow-up. In the ACS Israeli Survey, 1,060 consecutive patients with non-clinically diagnosed diabetes were admitted due to ACS; 359 patients with MS features on admission were compared with 701 subjects without MS. A modified National Cholesterol Education Program Adult Treatment Panel III definition of MS was used in patients who presented with > or =3 of the 5 components: (1) hyperglycemia, defined as occasional blood glucose on admission >140 mg/dl; (2) preexisting hypertension; (3) body mass index >28 kg/m(2); (4) high-density lipoprotein cholesterol < or =40 mg/dl (men) or < or =50 mg/dl (women); and (5) triglycerides > or =150 mg/dl. Patients with MS were more frequently women (27% vs 12%, p = 0.001), were in Killip > or =II on admission (19% vs 14%, p = 0.03), and had higher 30-day (5.0% vs 1.7%, p = 0.002) and 1-year (8.9% vs 4.6%, p = 0.005) crude mortality rates. Patients with hyperglycemia (glucose >140 mg/dl) and MS had higher 30-day mortality rates compared with patients with hyperglycemia without MS (8.3% vs 2.5%, p <0.05). Multivariate analysis identified MS as a strong independent predictor of 30-day and 1-year mortality with hazard ratios of 2.54 (95% confidence interval 1.22 to 5.31) and 1.96 (95% confidence interval 1.18 to 3.24), respectively. In conclusion, MS defined early at admission is a strong independent predictor of mortality and morbidity in patients with non-clinically diagnosed diabetes with ACS.
authors.affiliation: Heart Institute, Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Beer Sheba, Israel. micha.feinberg@sheba.health.gov.il
authors.forename: Micha S
authors.initials: MS
authors.lastname: Feinberg
authors.forename: Roseline
authors.initials: R
authors.lastname: Schwartz
authors.forename: David
authors.initials: D
authors.lastname: Tanne
authors.forename: Enrique Z
authors.initials: EZ
authors.lastname: Fisman
authors.forename: Hanoch
authors.initials: H
authors.lastname: Hod
authors.forename: Doron
authors.initials: D
authors.lastname: Zahger
authors.forename: Ehud
authors.initials: E
authors.lastname: Schwammethal
authors.forename: Michael
authors.initials: M
authors.lastname: Eldar
authors.forename: Solomon
authors.initials: S
authors.lastname: Behar
authors.forename: Alexander
authors.initials: A
authors.lastname: Tenenbaum
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000401:mortality*; D012042:Registries; D015996:Survival Rate; D013577:Syndrome; D013997:Time Factors