Is metabolic syndrome predictive of prevalence, extent, and risk of coronary artery disease beyond its components? Results from the multinational coronary CT angiography evaluation for clinical outcome: an international multicenter registry (CONFIRM).
Although metabolic syndrome is associated with increased risk of cardiovascular disease and events, its added prognostic value beyond its components remains unknown. This study compared the prevalence, severity of coronary artery disease (CAD), and prognosis of patients with metabolic syndrome to those with individual metabolic syndrome components. The study cohort consisted of 27125 consecutive individuals who underwent ≥ 64-detector row coronary CT angiography (CCTA) at 12 centers from 2003 to 2009. Metabolic syndrome was defined as per NCEP/ATP III criteria. Metabolic syndrome patients (n = 690) were matched 1:1:1 to those with 1 component (n = 690) and 2 components (n = 690) of metabolic syndrome for age, sex, smoking status, and family history of premature CAD using propensity scoring. Major adverse cardiac events (MACE) were defined by a composite of myocardial infarction (MI), acute coronary syndrome, mortality and late target vessel revascularization. Patients with 1 component of metabolic syndrome manifested lower rates of obstructive 1-, 2-, and 3-vessel/left main disease compared to metabolic syndrome patients (9.4% vs 13.8%, 2.6% vs 4.5%, and 1.0% vs 2.3%, respectively; p < 0.05), while those with 2 components did not (10.5% vs 13.8%, 2.8% vs 4.5% and 1.3% vs 2.3%, respectively; p > 0.05). At 2.5 years, metabolic syndrome patients experienced a higher rate of MACE compared to patients with 1 component (4.4% vs 1.6%; p = 0.002), while no difference observed compared to individuals with 2 components (4.4% vs 3.2% p = 0.25) of metabolic syndrome. In conclusion, Metabolic syndrome patients have significantly greater prevalence, severity, and prognosis of CAD compared to patients with 1 but not 2 components of metabolic syndrome.
Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Amir
A
Ahmadi
Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada.
Jonathon
J
Leipsic
Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
Gudrun
G
Feuchtner
Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.
Heidi
H
Gransar
Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York, United States of America.
Dan
D
Kalra
Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York, United States of America.
Ran
R
Heo
Department of Medicine, University of Erlangen, Erlangen, Germany.
Stephan
S
Achenbach
Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Daniele
D
Andreini
King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Mouaz
M
Al-Mallah
Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.
Daniel S
DS
Berman
Department of Medicine, Harbor UCLA Medical Center, Los Angeles, California, United States of America.
Matthew
M
Budoff
Department of Radiology, Giovanni XXIII Hospital, Monastier, Treviso, Italy.
Filippo
F
Cademartiri
Tennessee Heart and Vascular Institute, Hendersonville, Tennessee, United States of America.
Tracy Q
TQ
Callister
Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
Hyuk-Jae
HJ
Chang
William Beaumont Hospital, Royal Oaks, Michigan, United States of America.
Kavitha
K
Chinnaiyan
Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Benjamin
B
Chow
Baptist Cardiac and Vascular Institute, Miami, Florida, United States of America.
Ricardo C
RC
Cury
Capitol Cardiology Associates, Albany, New York, United States of America.
Augustin
A
Delago
Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York, United States of America.
Millie J
MJ
Gomez
Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany.
Martin
M
Hadamitzky
Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany.
Joerg
J
Hausleiter
Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York, United States of America.
Niree
N
Hindoyan
University Hospital, Zurich, Switzerland.
Philipp A
PA
Kaufmann
Seoul National University Hospital, Seoul, South Korea.
Yong-Jin
YJ
Kim
Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York, United States of America.
Fay
F
Lin
Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Erica
E
Maffei
Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Gianluca
G
Pontone
William Beaumont Hospital, Royal Oaks, Michigan, United States of America.
Gilbert L
GL
Raff
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America.
Leslee J
LJ
Shaw
Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America.
Todd C
TC
Villines
Duke Clinical Research Institute, Durham, North Carolina, United States of America.
Allison
A
Dunning
Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York, United States of America.
James K
JK
Min
D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality; D000368:Aged; D017130:Angioplasty; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality; D005260:Female; D006801:Humans; D007391:International Cooperation; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality; D015995:Prevalence; D011379:Prognosis; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed