Abstract 1267: Long Term Follow up of Acute Coronary Syndromes in Patients with Metabolic Syndrome
Metabolic syndrome (MS) increases the risk of acute coronary syndromes (ACSs). However, recent data have shown that among patients (pts) with ACSs, incidence of death and reinfarction is actually lower in obese pts compared to normal subjects, thereby questioning the prognostic value of obesity and MS in this setting. Since MS is thought to increase risk mainly on a long term basis, we have performed a long term follow up of pts with ACS, and evaluated how MS may affect prognosis. From 1995 to 2000 a total of 1,430 consecutive pts were admitted with a diagnosis of ACS; of these, 602 pts (42.2%) fulfilled the diagnostic criteria for MS. Patients were divided according to clinical presentation: STEMI or NSTEMI/UA, and then followed up. Patients with MS showed increased incidence of NSTEMI/UA (56.6% vs 48.6%; p<0.01), and concomitantly reduced incidence of STEMI (43.4% vs 51.4%; p<0.01). At multivariate analysis, after correcting for confounders, MS was an independent predictor of NSTEMI/UA. Patients with MS also showed in-hospital fewer complications (32.4% vs 39.5%; p<0.01) and lower mortality (2.3% vs 4.7%; p<0.05). However, despite apparently more benign clinical presentation and in-hospital outcome, at an average follow-up of 59+42 months pts with MS, on the whole, showed a worse prognosis, with increased cumulative incidence of reinfarction, angina, and heart failure. When pts were divided according to clinical presentation at index event, the negative long term impact of MS was mostly seen in those with NSTEMI/UA, while in pts with STEMI incidence of events was similar in both groups (Table⇓). Thus, in pts with ACSs MS may favor NSTEMI/UA over STEMI; this observation is consistent with reduced in-hospital complications and mortality, and may contribute to explain controversies about the short term prognostic value of obesity and metabolic syndrome. Over the long term, however, MS may exert a negative prognostic effect in patients who initially presented with NSTEMI/UA.