title: Risk of major adverse cardiovascular events in patients with metabolic syndrome after revascularization: A meta-analysis of eighteen cohorts with 18,457 patients.
abstract: OBJECTIVE
  To provide a comprehensive evaluation of the association between metabolic syndrome (MetS) and major adverse cardiovascular events (MACE) and to clarify the effect of revascularization methods among them in patients with coronary artery disease (CAD) undergoing successful revascularization.
  
  
  METHODS
  PubMed and Embase databases were searched. Cohort studies evaluating the association between MetS and risk of MACE and providing the hazard ratio (HR) with 95% confidence interval (CI) or sufficient data to calculate HR and its 95%CI among patients after revascularization were included. The pooled estimates were performed by using a random-effects model despite heterogeneity. Subgroup and sensitivity analyses were also conducted adherence to guidelines.
  
  
  RESULTS
  Eighteen trials with 18457 patients were included. Overall, MetS was associated with significant increased risks of MACE (HR 1.47, 95%CI 1.26-1.72, I(2)=46.4%, PH=0.016, P<0.001) and all-cause mortality (HR 1.58, 95%CI 1.29-1.92, I(2)=45.6%, PH=0.075, P<0.001) in CAD patients received revascularization. The results remained stable and robust in our subgroup analysis. However, no significant increased risk of MACE or all-cause mortality was found in patients undergoing coronary artery bypass graft (CABG) or drug-eluting stent (DES) in the sensitivity analysis.
  
  
  CONCLUSIONS
  MetS was associated with increased risks of MACE and all-cause mortality in patients after revascularization, but not in patients receiving CABG or DES. Therefore, prevention and treatment of MetS are extremely necessary in patients undergoing revascularization. Moreover, CABG and DES should be recommended for CAD patients with MetS and future researches are still warranted.
authors.affiliation: Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
authors.forename: Hong-Tao
authors.initials: HT
authors.lastname: Tie
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Shi
authors.affiliation: The First College of Clinical Medicine, Chongqing Medical University, Chongqing, 400016, China.
authors.forename: Zhen-Han
authors.initials: ZH
authors.lastname: Li
authors.affiliation: Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
authors.forename: Min
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China. Electronic address: qcwucq@163.com.
authors.forename: Qing-Chen
authors.initials: QC
authors.lastname: Wu
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications* / Q000453:epidemiology / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000706:statistics & numerical data; D006801:Humans; D024821:Metabolic Syndrome / Q000150:complications* / Q000453:epidemiology / Q000601:surgery*; D009204:Myocardial Revascularization / Q000009:adverse effects* / Q000401:mortality; D012307:Risk Factors
keywords: Major adverse cardiovascular events; Meta-analysis; Metabolic syndrome; Revascularization