Author + information
- Received December 18, 2012
- Revision received February 5, 2013
- Accepted February 14, 2013
- Published online August 20, 2013.
- Suzanne V. Arnold, MD, MHA∗,†∗ (, )
- Kasia J. Lipska, MD‡,
- Yan Li, PhD∗,
- Abhinav Goyal, MD, MHS§,
- Thomas M. Maddox, MD, MSc⋮,
- Darren K. McGuire, MD, MHSc¶,
- John A. Spertus, MD, MPH∗,† and
- Mikhail Kosiborod, MD∗,†
- ∗Saint Luke's Mid America Heart Institute, Kansas City, Missouri
- †University of Missouri-Kansas City, Kansas City, Missouri
- ‡Yale University School of Medicine, New Haven, Connecticut
- §Emory School of Medicine, Atlanta, Georgia
- ⋮VA Eastern Colorado Health Care System, Denver, Colorado
- ¶University of Texas Southwestern Medical Center, Dallas, Texas
Reprint requests and correspondence:
Dr. Suzanne V. Arnold, Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, Kansas City, Missouri 64111.
Objectives This study sought to examine the reliability and prognostic importance of an in-hospital diagnosis of metabolic syndrome (MetS) in the setting of acute myocardial infarction (AMI).
Background Because the factors that comprise MetS are believed to be altered in the setting of AMI, the diagnosis of MetS during AMI hospitalization and its prognostic significance have not been studied.
Methods We assessed patients within a multicenter registry for metabolic factors at baseline and 1 month post-AMI and followed them for mortality and rehospitalizations. The accuracy of an inpatient diagnosis of MetS was calculated using a 1-month follow-up as the gold standard. Patients were categorized based on MetS diagnosis at baseline and 1 month, and the combined endpoint of death or rehospitalization over 12 months was compared between groups.
Results Of the 1,129 patients hospitalized for AMI, diagnostic criteria for MetS were met by 69% during AMI hospitalization and 63% at 1 month. Inpatient MetS diagnosis had a sensitivity and specificity for outpatient diagnosis of 87% and 61%, respectively, and was associated with an 11 times increased odds of an outpatient diagnosis (C-index 0.74). Compared with patients without MetS during hospitalization and follow-up, patients classified as MetS during AMI but not follow-up had worse outcomes, whereas those classified MetS at follow-up had the worst outcomes (rates for combined endpoint 27% vs. 37% vs. 38%; log-rank p = 0.01).
Conclusions In a large cohort of patients with AMI, the diagnosis of MetS is common and can be made with reasonable accuracy during AMI. MetS is associated with poor outcomes, regardless of whether the diagnosis is confirmed during subsequent outpatient visit, and identifies a high-risk cohort of patients that may benefit from more aggressive risk factor modification.
The TRIUMPH study was sponsored by a grant from the National Institutes of Health (National Heart, Lung, and Blood Institute): Washington University School of Medicine SCCOR grant P50HL077113-01. This study was sponsored by Genentech. The funding organizations did not play a role in the design and conduct of the study or in the collection, management, analysis, and interpretation of the data. Dr. Arnold has received research grants from Genentech, Eli Lilly, Sanofi-Aventis, and Gilead Sciences. Dr. McGuire has received consultant honoraria from Janssen (Johnson & Johnson) Genentech, F. Hoffmann-LaRoche, Pfizer, Daiichi Sankyo, NovoNordisk, Sanofi-Aventis, Regeneron, and Tethys Bioscience; clinical trial leadership honoraria from Boehringer-Ingelheim, Takeda, Orexigen, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Daiichi Sankyo, and Merck Schering Plough; and research support from GlaxoSmithKline. Dr. Kosiborod has received research grants from the American Heart Association, Genentech, Sanofi-Aventis, Gilead Sciences, Medtronic Minimed, Glumetrics; and consultant honoraria from Medtronic Minimed, Genentech, Gilead Sciences, F. Hoffmann-LaRoche, and Boehringer-Ingelheim. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 18, 2012.
- Revision received February 5, 2013.
- Accepted February 14, 2013.
- American College of Cardiology Foundation