Metabolic syndrome severity score and long-term cardiovascular outcomes in patients with myocardial infarction with nonobstructive coronary arteries.

Abstract

Background and aim: Metabolic syndrome (MetS) is a cluster of metabolic disorders that promotes the risk of cardiovascular diseases. Beyond the dichotomous criteria of MetS, a continuous MetS scoring model enables the quantification of MetS severity and performs well in risk prediction. However, the impact of MetS score in myocardial infarction with nonobstructive coronary arteries (MINOCA) remains unclear. We aim to clarify the implications of MetS and its severity in a Chinese cohort of MINOCA.

Methods and results: A total of 1179 MINOCA patients were enrolled with a median follow-up of 41.7 months. An age-sex-ethnicity-specific MetS scoring model tailored to the Chinese adults was used to assess the MetS severity. The primary endpoint was a composite of major adverse cardiovascular events (MACE) including all-cause death, nonfatal MI, stroke, revascularization, and hospitalization for unstable angina or heart failure. Nearly a quarter of patients had MetS and they had worse outcomes after MINOCA. At multivariate Cox model, a higher MetS score was significantly associated with an increased risk of MACE (adjusted HR 2.00, 95 % CI: 1.47-2.74, p < 0.001). Restricted cubic splines analysis showed a non-linear relationship between the MetS score and event risk. At receiver-operating characteristic curves, the MetS score outperformed the binary defined MetS in predicting MACE and yielded a more accurate prognostic value in MINOCA.

Conclusions: The MetS severity score was an independent predictor of adverse events after MINOCA and thus may serve as a valuable tool for risk stratification, providing a rationale for the MetS score-guided interventions in MINOCA population.