Yatskar Leonid, Holper Elizabeth, Bansilal Sameer, Schwartzbard Arthur, Lombardero Manuel, Ramanathan Krishnan, Feit Frederick, Fisher Edward, Faxon David, Hochman Judith S, Farkouh Michael E
New York University School of Medicine, New York, NY, United States.
Atherosclerosis. 2008 Jun;198(2):389-95. doi: 10.1016/j.atherosclerosis.2007.09.046. Epub 2007 Dec 3.
The influence of metabolic syndrome (MS) on long-term mortality and morbidity in multi-vessel coronary artery disease (MV-CAD) is unclear. We studied the impact of MS on long-term outcomes in non-diabetic patients (NDM) with MV-CAD undergoing coronary revascularization in the Bypass Angioplasty Revascularization Investigation (BARI) trial and registry.
BARI trial and registry patients were separated into those with diabetes (DM) and those without. NDM fulfilling the NCEP definition of MS were identified. Ten year follow-up data were obtained on mortality, MI and development of diabetes. The data were analyzed using Cox proportional hazard modeling.
In the BARI trial and registry 2962 NDM were identified. Of those, 510 patients had 3 or more components of the BARI-modified NCEP definition for MS, while 445 patients had 2 components of the definition and were classified as the "mixed group". Compared to patients without MS, both MS group (RR=3.2, p<0.0001) and the mixed group (RR=1.9, p=0.02) had a higher incidence of DM over the 10-year follow-up. Type 2 DM was found to be highly associated with 10-year mortality (RR=1.65, p<0.0001). However, there was no statistically significant difference in the rate of death or MI at 5 and 10 years between NDM with or without MS. In multivariate analysis, the presence of MS was not associated with 10-year mortality in the BARI population (RR=0.93, p=0.62).
In this BARI follow-up study, we have affirmed the role of MS in predicting the development of diabetes in NDM at baseline. The 10-year risk of mortality and MI was not greater in NDM with MS who had MV-CAD and underwent revascularization, compared to patients without MS. Further studies to evaluate MS patients with MV-CAD undergoing coronary revascularization are warranted.
代谢综合征（MS）对多支冠状动脉疾病（MV-CAD）患者长期死亡率和发病率的影响尚不清楚。我们在旁路血管成形术血运重建研究（BARI）试验及注册研究中，研究了MS对接受冠状动脉血运重建的非糖尿病多支冠状动脉疾病（MV-CAD）患者长期预后的影响。
将BARI试验及注册研究的患者分为糖尿病患者（DM）和非糖尿病患者。确定符合美国国家胆固醇教育计划（NCEP）MS定义的非糖尿病患者。获取了关于死亡率、心肌梗死（MI）和糖尿病发生情况的10年随访数据。使用Cox比例风险模型对数据进行分析。
在BARI试验及注册研究中，共确定了2962例非糖尿病患者。其中，510例患者有3项或更多符合BARI改良NCEP MS定义的指标，而445例患者有2项该定义指标，被归为“混合组”。与无MS的患者相比，在10年随访期间，MS组（风险比[RR]=3.2，p<0.0001）和混合组（RR=1.9，p=0.02）的糖尿病发病率均较高。发现2型糖尿病与10年死亡率高度相关（RR=1.65，p<0.0001）。然而，有无MS的非糖尿病患者在5年和10年时的死亡或心肌梗死发生率无统计学显著差异。在多变量分析中，MS的存在与BARI研究人群的10年死亡率无关（RR=0.93，p=0.62）。
在这项BARI随访研究中，我们证实了MS在预测基线非糖尿病患者糖尿病发生方面的作用。与无MS的患者相比，患有MV-CAD并接受血运重建的非糖尿病MS患者的10年死亡和心肌梗死风险并不更高。有必要进一步开展研究，以评估接受冠状动脉血运重建的MV-CAD MS患者。
