Metabolic syndrome is associated with severe coronary artery disease and poor cardiac outcome in end-stage renal disease patients with acute coronary syndrome

Objective People with either end-stage renal disease or metabolic syndrome (MS) are at increased risk for developing coronary artery disease. The impact of MS on coronary artery disease in end-stage renal disease patients, however, remained unclear. We therefore evaluated whether the presence of MS is associated with more coronary lesions and a worse cardiac outcome in end-stage renal disease patients with acute coronary syndrome. Methods We retrospectively examined 76 consecutive end-stage renal disease patients who experienced acute coronary syndrome and underwent cardiac catheterization. Cardiovascular events were compared between the MS and non-MS group. Results MS was found in 58 patients and coronary artery disease was found in 63 patients [52 with MS (accounting for 90% of the MS group); 11 without MS (61% of the non-MS); MS vs. non-MS, P=0.011. Patients with MS had more multi-vessel coronary artery disease (P < 0.001) than those without MS. Sixty-nine (MS, 51; non-MS, 18) patients survived the acute coronary syndrome. During the follow-up period (MS, 17.6 +/- 13.8; non-MS, 19.9 +/- 11.7 months), 12 patients with MS (24%) and none without MS died owing to cardiovascular events (MS vs. non-MS, P=0.028). Regarding major cardiac events, including cardiac death, repeat non-fatal myocardial infarction, and repeat revascularization, the non-MS group had a higher probability of event-free survival (P < 0.0001). Conclusions In patients with end-stage renal disease complicated by acute coronary syndrome, MS is frequently seen and associated with a higher probability of coronary artery disease involving multiple coronary branches and a higher probability of cardiac death and major cardiac events. Therefore, detection of MS in such patients is useful for risk stratification.