Effects of metabolic syndrome on onset age and long-term outcomes in patients with acute coronary syndrome

doi:10.5847/wjem.j.1920-8642.2021.01.006

Abstract

Abstract:

BACKGROUND: We aim to investigate effects of metabolic syndrome on onset age and long-term outcomes in patients with acute coronary syndrome (ACS).

METHODS: Patients with ACS (n=6,431) who underwent percutaneous coronary intervention from January to December 2013 were enrolled. After excluding patients with previous coronary artery disease, 1,558 patients were diagnosed with early-onset ACS (men aged ≤50 years; women aged ≤60 years) and 3,044 patients with late-onset ACS. Baseline characteristics and five-year clinical outcomes were measured.

RESULTS: Body mass index, triglyceride, low-density lipoprotein cholesterol, and uric acid concentrations were significantly higher, while the high-density lipoprotein cholesterol (HDL-C) concentration was lower in the early-onset ACS group (P<0.001). Multivariate logistic regression revealed obesity (odds ratio [OR] 1.590, 95% confidence interval [CI] 1.345-1.881), hypertriglyceridemia (OR 1.403, 95% CI 1.185-1.660), and low HDL-C (OR 1.464, 95% CI 1.231-1.742) as independent risk factors for early-onset ACS (all P<0.001). The five-year follow-up showed that the incidences of all cause death (1.5% vs. 3.8%, P<0.001), cardiac death (1.1% vs. 2.0%, P=0.023), and recurrent stroke (2.2% vs. 4.2%, P<0.001) were lower, while bleeding events were more frequent in the early-onset ACS group. A subgroup analysis showed higher incidences of recurrent myocardial infarction (MI) and revascularization in patients with early-onset ACS and metabolic syndrome.

CONCLUSIONS: Obesity, hypertriglyceridemia, and lower HDL-C level are independent risk factors for early-onset ACS, recurrent MI, and revascularization. The control of metabolic syndrome may reduce the incidence of early-onset ACS and improve the long-term prognosis.

Key words: Age, Coronary artery disease, Acute coronary syndrome, Metabolic syndrome

Jing-jing Xu, Ying Song, Ping Jiang, Lin Jiang, Xue-yan Zhao, Zhan Gao, Jian-xin Li, Shu-bin Qiao, Run-lin Gao, Yue-jin Yang, Yin Zhang, Bo Xu, Jin-qing Yuan. Effects of metabolic syndrome on onset age and long-term outcomes in patients with acute coronary syndrome[J]. World Journal of Emergency Medicine, 2021, 12(1): 36-41.

Figures/Tables 4

Table 1

Patients’ baseline characteristics between two groups

Parameters	Early-onset ACS (n=1,558)	Late-onset ACS (n=3,044)	P-value
Demographics
Age (years)	47.27±6.30	63.17±7.60	<0.001^*
Female, n (%)	404 (25.9)	737 (24.2)	0.201
BMI (kg/m²)	26.49±3.31	25.51±3.13	<0.001^*
Risk factors and medical history, n (%)
Hypertension history	946 (60.7)	1,959 (64.4)	0.016^*
Diabetes mellitus	391 (25.1)	866 (28.4)	0.016^*
Hyperlipidemia	1,103 (65.0)	1,915 (62.9)	0.159
Family history of CAD	431 (27.7)	690 (22.7)	<0.001^*
Smoking history	895 (57.4)	1,696 (55.7)	0.510
Previous stroke	79 (5.1)	392 (12.9)	<0.001^*
Peripheral vascular disease	16 (1.0)	69 (2.3)	0.003^*
Examination
White blood cell count before PCI (×10⁹/L)	7.12±1.91	6.90±1.85	<0.001^*
HGB before PCI (g/L)	143.46±15.43	139.26±16.27	<0.001^*
PLT before PCI (×10⁹/L)	223.58±57.09	206.97±56.22	<0.001^*
HbAlc (%)	6.53±1.33	6.56±1.18	0.483
B-brain natriuretic peptide (pg/mL)	680.73±386.46	804.05±719.57	<0.001^*
Big endothelin (pmol/L)	0.26±0.22	0.29±0.27	<0.001^*
Erythrocyte sedimentation rate (mm/h)	11.35±11.46	12.51±12.66	0.003^*
TC (mmol/L)	4.35±1.13	4.21±0.99	<0.001^*
LDL-C (mmol/L)	2.62±0.96	2.52±0.85	<0.001^*
HDL-C (mmol/L)	0.98±0.27	1.05±0.29	<0.001^*
Triglyceride (mmol/L)	2.04±1.27	1.70±0.97	<0.001^*
Uric acid (μmol/L)	348.50±87.75	334.56±83.25	<0.001^*
eGFR (mL/[minute·1.73 m²])	100.82±11.81	87.36±14.11	<0.001^*
LVEF (%)	63.52±6.54	63.27±6.78	0.229
Angiographic and procedural characteristics
LM or 3-vessel disease, n (%)	60 (3.9)	124 (4.1)	0.715
Complex lesion (lesion of type B2 or C), n (%)	1,158 (74.3)	2,291 (75.3)	0.488
Bifurcation disease, n (%)	308 (19.8)	582 (19.1)	0.598
Occlusion disease, n (%)	323 (20.7)	524 (17.2)	0.004^*
Syntax score	11.11±7.42	11.97±7.89	<0.001^*
Number of target lesion	1.41±0.68	1.41±0.65	0.632
Number of stents per patient	1.78±1.11	1.83±1.05	0.127
Antiplatelet therapy duration
Aspirin duration >1 year, n (%)	1,533 (98.4)	2,965 (97.1)	0.008^*
Clopidogrel duration >1 year, n (%)	1,502 (96.4)	2,921 (96.0)	0.459
Dual antiplatelet therapy >1 year, n (%)	1,067 (68.5)	2,016 (66.2)	0.123
ACS type, n (%)
STEMI	436 (28.0)	637 (20.9)	<0.001^*
NSTEMI	128 (8.2)	241 (7.9)	0.502
UA	994 (63.8)	2,166 (71.2)	<0.001^*

Table 1

Table 2

Table 3

Figure 1.

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Parameters	OR	95% CI	P-value
Female	1.470	1.219-1.774	<0.001^*
Obesity (body mass index ≥28 kg/m²)	1.590	1.345-1.881	<0.001^*
Hypertension	0.697	0.596-0.817	<0.001^*
Diabetes mellitus	0.808	0.683-0.955	0.012^*
Hypertriglyceridemia (triglyceride ≥1.7 mmol/L)	1.403	1.185-1.660	<0.001^*
Low HDL-C (HDL-C <1.04 mmol/L)	1.464	1.231-1.742	<0.001^*
Family history of coronary artery disease	1.247	1.078-1.443	0.003^*
Smoking	1.097	0.940-1.282	0.240
Total cholesterol	1.089	0.907-1.308	0.361
LDL-C	1.004	0.820-1.229	0.971
Uric acid	1.002	1.000-1.002	0.002^*
Three to five metabolic syndrome components	1.902	0.863-1.381	0.465

Parameters	Hospitalization events			Five-year follow-up events
Parameters	Early-onset ACS (n=1,558)	Late-onset ACS (n=3,044)	P-value	Early-onset ACS (n=1,558)	Late-onset ACS (n=3,044)	P-value
MACCEs	18 (1.2)	51 (1.7)	0.169	262 (16.8)	662 (21.7)	<0.001^*
All-cause death	2 (0.1)	6 (0.2)	0.596	24 (1.5)	117 (3.8)	<0.001^*
Cardiac death	2 (0.1)	5 (0.2)	0.768	17 (1.1)	61 (2.0)	0.023^*
Recurrent myocardial infarction	17 (1.1)	45 (1.5)	0.281	81 (5.2)	191 (6.3)	0.143
Stent thrombosis	3 (0.2)	8 (0.3)	0.644	-	-	-
Target vessel revascularization	-	-	-	195 (12.5)	392 (12.9)	0.728
Recurrent stroke	0 (0)	0 (0)	1.000	34 (2.2)	127 (4.2)	0.001^*
Bleeding (BARC 2 to 5)	1 (0.1)	3 (0.1)	0.708	255 (16.4)	377 (12.4)	<0.001^*

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