The effect of the presence of metabolic syndrome criteria on the post-infarction course in patients with acute myocardial infarction with ST-segment elevation
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Abstract
The aim – to assess the additional prognostic information of metabolic syndrome (MS) components in groups of patients with acute myocardial infarction with segment elevation ST (STEMI), equalized in terms of commonly used acute coronary syndrome (ACS) risk factors.
Materials and methods. Retrospective analysis of the 820 cases of STEMI included: evaluation of risk factors according to the scales TIMI, GRACE, PURSUIT, and evaluation of components of the metabolic syndrome at entry (the presence of diabetes mellitus and/or increasing glucose levels > 7 mmol/l, overweight, hypertension, dyslipidemia), as well as the assessment of the indicators of clinical course of hospital period of MI, treatment and results of follow-up of patients, including the information about cases of cardiac death.
Results and discussion. Via automated «case-match-control» algorhythm from the basic cohort 2 groups were selected: group 1 (n=41, patients with MS) and group 2 (n=123, patients without MS). Matching criteria included following 13 risk factors: age, height, presence of heart failure, smoking, systemic hypotension at the 1 day of AMI, presence of anterior STEMI, the peak level of the MB-CK and AST, a history of angina and the period of unstable angina before STEMI, the presence of previous MI, baseline heart rate, baseline glomerular filtration rate (CKD-EPI), male gender. Groups were exactly matched by the first 4 matching criteria, and among other criteria maximum mismatch of 3 criteria was allowed (mean mismatch was 1.87 criteria from 13 per pair, and there were no significant differences in groups by each of 13 matching criteria). Otherwise, group 1 was characterized by more severe baseline profile, clinical course of hospital period, but it has the more intensive medical treatment also (including more frequent prescription of ACE inhibitors). According to the follow-up data, patients in group 1 had smaller end-systolic and end-diastolic indexes, more signed improvement in acute heart failure rate, higher heart rate variability and smaller dispersion of repolarisation at the 10th day. Also there was observed a trend toward a lower 3-year mortality (4,9 versus 17,1 %; p=0.05).
Conclusions. The presence of MS accompanying STEMI is associated with poorer course of acute period of the disease and, in a contrary, with more favorable course of post-infarction period because of more intensive cardiac therapy in this group of patients.
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