The reliability and prognosis of in-hospital diagnosis of metabolic syndrome in the setting of acute myocardial infarction

Suzanne V. Arnold, Kasia J. Lipska, Yan Li, Abhinav Goyal, Thomas M. Maddox, Darren K. McGuire, John A. Spertus, Mikhail Kosiborod

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)704-708
Number of pages5
JournalJournal of the American College of Cardiology
Volume62
Issue number8
DOIs
StatePublished - Aug 20 2013
Externally publishedYes

Keywords

  • long-term outcomes metabolic syndrome myocardial infarction

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