| Abstract | Ovo je prospektivno istraživanje utjecaja metaboličkoga sindroma (MetS), dijagnosticiranog revidiranim National Cholesterol Education Program Adult Treatment Panel III kriterijima, i antropometrijskih parametara (indeks tjelesne mase (BMI), opseg struka (WC), omjer opsega struka i bokova (WHR)) na težinu i prognozu akutnoga infarkta miokarda sa ST-elevacijom (STEMI), te po prvi puta na zahvaćenost koronarnih segmenata (KS) signifikantnom stenozom i duljinu bolovanja. Provedeno je na 250 bolesnika s akutnim STEMI, liječenih primarnom perkutanom koronarnom intervencijom u Zavodu za kardiovaskularne bolesti KBC-a Sestre Milosrdnice, od rujna 2011. do rujna 2012. godine. Bolesnici sa i bez MetS, te oni s različitim BMI, WC i WHR kategorijama, evaluirani su prema osnovnim (medicinski, demografski), te prema parametrima težine (klinički, laboratorijski, ehokardiografski, koronarografski, bolničke komplikacije) i prognoze (glavni neželjeni kardiovaskularni događaji (MACE) (reinfarkt, koronarna restenoza i/ili nova stenoza, kardiogeni i/ili nekardiogeni uzroci rehospitalizacije, moždani udar, hitno aortokoronarno premoštenje, smrtnost, ukupni MACE) i duljina bolovanja tijekom 12 mjeseci) akutnog STEMI. MetS povećava rizik ukupnih bolničkih komplikacija i značajnih stenoza 2 koronarnih arterija. Bolesnici imaju dulju hospitalizaciju, šire stentove, učestalije značajno stenozirane proksimalne/srednje KS i dulje bolovanje. Hiperglikemija povećava rizik srčane insuficijencije. BMI <25.0 kg/m2 povećava, a BMI 25.0-29.9 kg/m smanjuje rizik dispneje. Bolesnici sa BMI 30.0 kg/m2 imaju dulju hospitalizaciju i šire stentove, dok oni s povišenim WHR imaju učestalije signifikantno stenozirane proksimalne/srednje KS. Konačno, broj signifikantno stenoziranih koronarnih arterija povećava rizik ukupnog MACE. Zaključno, MetS je superioran u odnosu na njegove komponente i antropometriju u predviđanju težine akutnog STEMI, ali bez značajnih razlika među njima u predviđanju prognoze. MetS bolesnici imaju dulje bolovanje, što je vrlo bitno u budućem planiranju njihove rehabilitacije. |
| Abstract (english) | Objective: Investigation the influence of metabolic syndrome (MetS) and anthropometric parameters on clinical severity and prognosis in patients with acute ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). Patients and Methods: We prospectively analysed 250 patients with acute STEMI treated with primary PCI, between September 2011-2012, in Department for Cardiovascular Diseases, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia. MetS was diagnosed by the revised National Cholesterol Education Program Adult Treatment Panel III criteria. Patients were divided in two groups (with/without MetS) which were compared by their baseline (medical history, demographic) and parameters of severity (clinical, laboratory, echocardiography, coronary angiography and in-hospital complications data) and prognosis (major adverse cardiovascular events (MACE) (reinfarction, coronary arteries restenosis and/or new stenosis, cardiac and/or non-cardiac rehospitalization, cerebrovascular insult, urgent coronary artery bypass graft, mortality, and total MACE) and sick leave duration during 12 months follow-up period). Additionally, patients were divided according to the anthropometric parameters in three groups as follows: body mass index (BMI) (<25.0, 25.0-29.9 and 30.0 kg/m), waist circumference (WC) (<102/88 and 102/88 cm for males/females) and waist-to-hip ratio (WHR) (<0.90/0.85 and 0.90/0.85 for males/females). They were analysed and compared by the same baseline and parameters of severity and prognosis. Results: There were 136 (54.4%) and 114 (45.6%) patients with and without MetS, respectively. MetS patients had longer hospitalization (9.0 vs. 8.0 days), higher rates of total in-hospital complications (47.8% vs. 34.2%), higher number of significant stenosed coronary arteries (2 vs. 1), wider stents diameter (3.5 vs. 3.0 mm), higher rate of significant stenosed proximal/middle coronary arteries segments (94.1% vs. 86.7%), and longer sick leave duration (16 vs. 10 weeks) (p<0.05). MetS was independently associated with higher risk of total in-hospital complications (Odds ratio (OR) 1.76, Confidence interval (CI) [1.05-2.94], p=0.031) and with higher risk of 2 significant stenosed coronary arteries (OR 1.72, CI [1.04-2.84], p=0.034). Among the same 250 patients, there were 72 (28.8%), 149 (59.6%) and 222 (88.8%) patients with BMI 30.0 kg/m, WC 102/88 cm and WHR 0.90/0.85, respectively. Patients with BMI <25.0 kg/m had highest rates of dyspnea, those with BMI 30.0 kg/m2 had longer hospitalization and wider diameter of stents, and those with WHR 0.85/0.90 had higher rates of significant stenosed proximal/middle coronary arteries segments (p<0.05). BMI <25.0 kg/m2 was independently associated with higher (OR 2.0, CI [1.10-3.67], p=0.025) and BMI 25.0-29.9 kg/m2 with lower risk of dyspnea (OR 0.51, CI [0.29-0.90], p=0.020). Finally, number of significantly stenosed coronary arteries was independently associated with total MACE (OR 1.79, CI [1.17-2.77], p=0.008). Conclusion: MetS in acute STEMI is an independent predictor of total in-hospital complications and severity of coronary arteries disease, but not for other parameters of severity and prognosis. BMI is an independent predictor for some components of severity (but not prognosis) in acute STEMI, while WC and WHR seems to be inferior in that prediction with no impact on both severity and prognosis in these patients. |
