Impact of metabolic syndrome on various aspects of microcirculation and major adverse cardiac events in patients with ST-segment elevation myocardial infarction.
BACKGROUND
Microvascular impairment is associated with a poor prognosis even after successful percutaneous coronary intervention (PCI) in acute myocardial infarction. The aim of the present study was to examine the impact of metabolic syndrome (MetS) on various aspects of microvascular function and clinical outcomes.


RESULTS
In 216 consecutive patients with ST-segment elevation myocardial infarction (STEMI) after successful primary PCI, data were collected and analyzed on epicardial coronary flow, ST-segment resolution (STR) on electrocardiography, maximum serum creatine kinase levels, and the incidence of major adverse cardiac events (MACE). The prevalence of MetS was 40.7% (88 patients). Corrected Thrombolysis In Myocardial Infarction frame count was significantly higher in the MetS group than in the non-MetS group (28.1±9.4 vs. 24.7±7.9, P=0.04). STR ≥50% was observed in 51.1% and 69.5%, respectively (P=0.01). Patients with MetS also had higher maximum creatine kinase levels (3,470±2,320IU/L vs. 2,664±1,850IU/L, P=0.01). On logistic regression analysis after adjustment for confounders, MetS was an independent negative predictor of complete STR (odds ratio, 0.49; 95% confidence interval [CI]: 0.25-0.95, P=0.03). On Cox multivariate analysis, MetS was an independent predictor for MACE (hazard ratio, 4.85; 95% CI: 1.28-18.3, P=0.02).


CONCLUSIONS
MetS may damage microcirculation after direct PCI in patients with STEMI and lead to poor prognosis.
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan. y-uchida1122@sepia.ocn.ne.jp
Yasuhiro
Y
Uchida
Satoshi
S
Ichimiya
Hideki
H
Ishii
Masaaki
M
Kanashiro
Junji
J
Watanabe
Daiji
D
Yoshikawa
Kyosuke
K
Takeshita
Shinichi
S
Sakai
Tetsuya
T
Amano
Tatsuaki
T
Matsubara
Toyoaki
T
Murohara
D000368:Aged; D003326:Coronary Circulation; D003402:Creatine Kinase / Q000097:blood; D006801:Humans; D015994:Incidence; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D008833:Microcirculation; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D015995:Prevalence
D003402:Creatine Kinase