Effect of Metabolic Syndrome on Long-term Prognosis of Patients with ST-segment Elevation Myocardial Infarction

doi:10.12114/j.issn.1007-9572.2019.00.578

Abstract

Abstract: Background　Metabolic syndrome（MetS） is a collection of conditions，which increases the risk for cardiovascular and cerebrovascular diseases.Its influence on long-term prognosis of ST-segment elevation myocardial infarction（STEMI） patients is rarely reported.Objective　To evaluate the impact of MetS on long-term prognosis of STEMI patients.Methods　We enrolled 507 STEMI patients treated with PCI from Cardiovascular Department，Central South University Xiangya School of Medicine Affiliated Haikou Hospital from March 2014 to March 2015，including 217 with coexisting MetS（MetS group），and 290 without（non-MetS group）．We collected their general clinical data，and information about severity of conditions，length of stay，incidence of complications during hospitalization，pharmacological treatment within one-month follow-up，and major adverse cardiovascular events（MACE） and death within four-year follow-up.We performed a multivariate analysis of the impact of MetS on MACE and death using the Cox proportional hazard regression model.Results　Both groups showed significant differences in sex ratio，mean age，prevalence of history of smoking，hypertension，diabetes，hyperlipidemia，low HDL cholesterol，central obesity，distribution of BMI，and multi-vessel lesions，as well as mean SYNTAX score（P<0.05）．Also，MetS group showed longer mean length of stay than non-MetS group （P<0.05）.At one-month follow-up，the rates of using ACEIs/ARBs，calcium channel blockers，and hypoglycemic agents in MetS group were higher than those of non-MetS group（P<0.05）．During the four-year follow-up，MetS group had higher incidence of angina pectoris，and target vessel revascularization，and lower incidence of receiving repeat PCI/coronary artery bypass grafting than no-MetS group（P<0.05）．The death rate differed significantly by the number of MetS components（P<0.05）．The incidence of MACE also varied significantly by the number of MetS components（P<0.05）．Multivariate analysis with the Cox proportional hazards regression model showed that age 〔HR=1.057，95%CI（1.022，1.090）〕，renal insufficiency 〔HR=3.025，95%CI（1.180，7.759）〕，previous myocardial infarction〔HR=2.430，95%CI（1.488，5.151）〕，left ventricular ejection fraction 〔HR=0.958，95%CI（0.923，0.995）〕，Killip class≥Ⅱ 〔HR=4.641，95%CI（2.188，9.825）〕 were independent risk factors for death in STEMI patients（P<0.05）；age 〔HR=1.029，95%CI（1.006，1.054）〕，renal insufficiency 〔HR=2.826，95%CI（1.229，6.496）〕，left ventricular ejection fraction 〔HR=0.960，95%CI（0.934，0.987）〕，SYNTAX score 〔HR=2.138，95%CI（1.281，3.567）〕，Killip class≥Ⅱ 〔HR=2.098，95%CI（1.131，3.893）〕 and MetS 〔HR=1.833，95%CI（1.162，2.896）〕were independent risk factors for MACE in STEMI patients（P<0.05）．MetS was independently associated with TVR 〔HR=2.204，95%CI（1.273，3.815），P=0.005〕.Conclusion　STEMI patients with MetS had longer length of stay and higher long-term MACE incidence after PCI.MetS is not associated with long-term death of STEMI patients，but is independently associated with MACE，especially with TVR.

Key words: Myocardial infarction；Metabolic syndrome；Angioplasty, balloon, coronary；Myocardial revascularization；Major adverse cardiac events；Prognosis

摘要： 背景　代谢综合征是一种多症候群的综合征，也是心脑血管疾病的危险因素，代谢综合征对ST段抬高型心肌梗死（STEMI）患者远期预后的影响鲜见报道。目的　探讨代谢综合征对STEMI患者远期预后的影响。方法　选取2014年3月—2015年3月中南大学湘雅医学院附属海口医院心血管内科接受经皮冠状动脉介入治疗（PCI）的STEMI患者507例，根据是否合并代谢综合征分为代谢综合征组217例和非代谢综合征组290例。收集患者入院时一般临床资料、病情程度、住院时间、住院期间并发症发生率、随访1个月内用药情况及随访4年死亡、主要不良心血管事件（MACE）发生情况。代谢综合征对死亡和MACE的影响采用多因素Cox比例风险回归分析。结果　代谢综合征组与非代谢综合征组患者性别、年龄、吸烟史、高血压、糖尿病、高脂血症、低高密度脂蛋白胆固醇血症、中心性肥胖、体质指数（BMI）分布、多支病变所占比例、SYNTAX评分比较，差异均有统计学意义（P<0.05）。代谢综合征组患者住院时间长于非代谢综合征组（P<0.05）。随访1个月内，代谢综合征组患者血管紧张素转换酶抑制剂（ACEI）/血管紧张素Ⅱ受体阻滞剂（ARB）、钙离子通道阻滞剂（CCB）和降糖药使用率高于非代谢综合征组（P<0.05）。随访4年，代谢综合征组患者心绞痛、靶血管血运重建（TVR）发生率高于非代谢综合征组，新PCI/冠状动脉旁路移植术（CABG）发生率低于非代谢综合征组（P<0.05）。不同代谢综合征组分数量者死亡率比较，差异无统计学意义（P>0.05）；不同代谢综合征组分数量者MACE发生率比较，差异有统计学意义（P<0.05）。多因素Cox比例风险回归模型分析结果显示，年龄〔HR=1.057，95%CI（1.022，1.090）〕、肾功能不全〔HR=3.025，95%CI（1.180，7.759）〕、既往心肌梗死〔HR=2.430，95%CI（1.488，5.151）〕、左心室射血分数〔HR=0.958，95%CI（0.923，0.995）〕、Killip分级≥Ⅱ级〔HR=4.641，95%CI（2.188，9.825）〕是STEMI患者死亡的独立危险因素（P<0.05）；年龄〔HR=1.029，95%CI（1.006，1.054）〕、肾功能不全〔HR=2.826，95%CI（1.229，6.496）〕、左心室射血分数〔HR=0.960，95%CI（0.934，0.987）〕、SYNTAX评分〔HR=2.138，95%CI（1.281，3.567）〕、Killip分级≥Ⅱ级〔HR=2.098，95%CI（1.131，3.893）〕、代谢综合征〔HR=1.833，95%CI（1.162，2.896）〕是STEMI患者发生MACE的独立危险因素（P<0.05）。代谢综合征与TVR独立相关〔HR=2.204，95%CI（1.273，3.815），P=0.005〕。结论　STEMI合并代谢综合征患者PCI后住院时间更长，远期MACE发生率更高；代谢综合征与STEMI患者远期死亡无关，但是与MACE独立相关，尤其是与TVR密切相关。

关键词: 心肌梗死, 代谢综合征, 血管成形术, 气囊, 冠状动脉, 心肌血管重建术, 主要不良心血管事件, 预后

CHEN Hairong,LI Minglan,PAN Biyun, et al. Effect of Metabolic Syndrome on Long-term Prognosis of Patients with ST-segment Elevation Myocardial Infarction　[J]. Chinese General Practice, 2020, 23(17): 2126-2131. DOI: 10.12114/j.issn.1007-9572.2019.00.578.
陈海荣,李名兰,潘碧云等. 代谢综合征对ST段抬高型心肌梗死患者远期预后的影响研究[J]. 中国全科医学, 2020, 23(17): 2126-2131. DOI: 10.12114/j.issn.1007-9572.2019.00.578.

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