title: Impact of metabolic syndrome on clinical outcomes after new generation drug-eluting stent implantation: the 'obesity paradox' phenomenon is still apparent.
abstract: OBJECTIVE
  New generation drug-eluting stents (DES) have improved clinical outcomes. However, their impact on patients with metabolic syndrome (MS) is still unclear as there is no sufficient data. Therefore, we evaluated the impact of the new generation DES on patients with an isolated lesion in the proximal segment of the left anterior descending artery (pLAD) suffering from MS.
  
  
  RESULTS
  We evaluated 511 patients with a pLAD lesion. Of these, 147 patients had MS. The major adverse cardiac events (MACE) including death, non-fatal myocardial infarction (MI) and target lesion revascularization (TLR) were defined as primary end points. Stent thrombosis was also evaluated. MACEs had a trend to be higher in non-MS group (8.24% vs 3.40%, p = 0.05) during 20 months mean follow-up period. Rates of cardiac death (1.37% vs 0.68%, p = 0.67), non-fatal MI (1.92% vs 0.0%, p = 0.20), TLR (4.94% vs 2.04% MS, p = 0.21) and thrombosis (3.29% vs 1.36%, p = 0.36) were not significantly different in non-MS and MS group. The Kaplan-Meier curve revealed: MS group: 96.59% vs non-MS group: 91.75% (p = 0.04). MS was a favorable independent predictor for MACE (hazard ratio (HR) 0.34, 95% confidence interval (CI) 0.12-0.93, p < 0.03). In addition, independent predictors for MACE were BMI ≥ 30 kg/m(2) (HR 0.87 95% CI 0.79-0.96 p = 0.008) and diabetes mellitus (HR 2.01 95% CI 0.99-4.11, p = 0.05).
  
  
  CONCLUSIONS
  The 'obese paradox' phenomenon is found in the era of new generation DES. In order to investigate the underlying mechanism for this phenomenon further studies are required.
authors.affiliation: First Department of Cardiology, Athens Medical School, Hippokration Hospital, 114 Vas. Sophias Str, 11527 Athens, Greece. chrysoulapatsa@hotmail.com
authors.forename: C
authors.initials: C
authors.lastname: Patsa
authors.forename: K
authors.initials: K
authors.lastname: Toutouzas
authors.forename: E
authors.initials: E
authors.lastname: Tsiamis
authors.forename: C
authors.initials: C
authors.lastname: Tsioufis
authors.forename: A
authors.initials: A
authors.lastname: Spanos
authors.forename: A
authors.initials: A
authors.lastname: Karanasos
authors.forename: A
authors.initials: A
authors.lastname: Michelongona
authors.forename: D
authors.initials: D
authors.lastname: Tousoulis
authors.forename: C
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D000368:Aged; D015992:Body Mass Index; D016009:Chi-Square Distribution; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D003920:Diabetes Mellitus / Q000453:epidemiology; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome