Metabolic syndrome does not increase angiographic restenosis rates after drug-eluting stent implantation

Metabolic syndrome (MS) is associated with an increased risk of coronary heart disease, stroke, and cardiovascular mortality; but its effect on patients undergoing cardiac revascularization is still unclear. Robust evidence demonstrates that diabetes mellitus and insulin resistance are among the main risk factors for restenosis in patients requiring percutaneous myocardial revascularization. The recent advent of drug-eluting stents (DESs) has significantly reduced the incidence of restenosis compared with bare-metal stents, both in nondiabetic and in diabetic patients. The aim of the study was to evaluate the effect of MS on the risk of binary restenosis in DES implant recipients. One hundred eighty-nine recipients of successful DES implants performed between January and March 2005 for stable coronary artery disease underwent 1-year clinical and angiographic follow-up. Body mass index (BMI), blood pressure, fasting blood glucose, and lipid profile were determined. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria, with the waist criterion being substituted by a BMI ≥28.8 kg/m2. Metabolic and anthropometric information for MS diagnosis was available for 148 of 189 patients; 87 of 148 patients (58%) had MS. Patients with MS had higher BMI (28.4 ± 3.8 vs 26 ± 2.7 kg/m2, P < .0001), systolic blood pressure (133 ± 14 vs 124 ± 14 mm Hg, P = .0004), and fasting glucose (113 ± 37 vs 92 ± 17 mg/dL, P < .0001). They also had higher serum triglycerides (154 ± 94 vs 113 ± 43, P = .0018) and lower high-density lipoprotein cholesterol levels (39 ± 9 vs 46 ± 10, P < .0001). Rates of restenosis (10.5% vs 8.1%, P = not significant [NS]), target vessel revascularization (10.5% vs 11.3%, P = NS), and major adverse cardiac events (11.6% vs 14.5%, P = NS) were not significantly different in patients with MS compared with those without MS, nor was any association found between increased end point risk and presence of MS. When patients were subdivided into 6 subgroups by the presence of 0, 1, 2, 3, 4, or 5 of the MS components, restenosis rates were not significantly different among subgroups. In conclusion, MS is not associated with higher rates of restenosis, target vessel revascularization, or major adverse cardiac events; and no additional MS feature was associated with an increased risk.