1. Associations Between Metabolic Syndrome and Long-Term Mortality in Patients who underwent Percutaneous Coronary Intervention: An Australian Cohort Analysis.
- Author
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O'Brien JM, Dinh D, Roberts L, Teh A, Brennan A, Duffy SJ, Clark D, Ajani A, Oqueli E, Sebastian M, Reid C, Econ CH, Freeman M, and Chandrasekhar J
- Subjects
- Humans, Male, Female, Middle Aged, Australia epidemiology, Retrospective Studies, Aged, Risk Factors, Registries, Coronary Artery Disease mortality, Coronary Artery Disease surgery, Coronary Artery Disease complications, Prevalence, Prognosis, Follow-Up Studies, Survival Rate trends, Time Factors, Percutaneous Coronary Intervention, Metabolic Syndrome complications, Metabolic Syndrome epidemiology
- Abstract
Metabolic syndrome (MetS) provides significant risk for coronary disease, however long-term prognosis after percutaneous coronary intervention (PCI) has been understudied. We assessed the prevalence and outcomes of patients with MetS from an Australian PCI cohort. We retrospectively examined data from the Melbourne Interventional Group multicenter PCI registry using a modified definition for MetS including ≥3 of the following: hypertension, diabetes mellitus, dyslipidemia, and body mass index ≥30 kg/m
2 . Thirty-day outcomes and long-term mortality were compared with patients without MetS. Cox regression methods were used to assess the multivariable effect of MetS on long-term mortality. Of 41,146 patients, 12,228 (34%) had MetS. Patients with MetS experienced greater 30-day myocardial infarction (2.2% vs 1.8%, p = 0.013), whereas patients without MetS had a trend for greater 30-day mortality (3.0% vs 3.4%, p = 0.051) and greater in-hospital major bleeding (1.7% vs 2.4%, p <0.001). After a median follow-up of 5.62 years (Q1 2.03, Q3 8.89), patients with MetS experienced greater mortality (24% vs 19%, p <0.001). After adjustment, MetS was not an independent predictor of long-term mortality (hazard ratio 0.95 confidence interval 0.86 to 1.05, p = 0.35). In sensitivity analyses, MetS-Diabetic patients had the highest, and MetS-NonDiabetic obese patients had the lowest long-term mortality. One in 3 patients who underwent all-comer PCI presented with MetS and experienced greater long-term mortality compared with others. However, this association was lost after adjustment for baseline confounders, highlighting that MetS is a marker of risk after PCI. Our findings support the obesity paradox and confirm robust associations between diabetes mellitus and long-term mortality., Competing Interests: Declaration of competing interest Jaya Chandrasekhar reports statistical analysis was provided by Melbourne Interventional Group. MIG receives grant funding from the following: Abbott Laboratories, Bristol Myers Squibb, AstraZeneca, Medtronic and Pfizer. These companies do not have access to the data and do not have the right to review articles before publication. Professor Stephen Duffy's and Professor Christopher Reid's work is supported by National Health and Medical Research Council of Australia grants. The remaining authors have no competing interests to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)- Published
- 2024
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