Impact of the metabolic syndrome on angiographic and clinical events after coronary intervention using bare-metal or sirolimus-eluting stents.

Patients with metabolic syndrome (MS) are at increased risk for cardiovascular events. Although the number of patients with MS requiring coronary revascularization is increasing rapidly, the impact of MS on clinical events and restenosis in patients who undergo stent placement is not well defined. Seven hundred thirty-four consecutive patients with 734 de novo coronary lesions (<50 mm lesion length, reference vessel diameter <3.5 mm) were enrolled in this study. Four hundred thirty-seven patients were treated with bare-metal stents, and 297 patients were treated with sirolimus-eluting stents. Patients with bifurcation lesions, left main lesions, and ST-segment-elevation myocardial infarctions were excluded from the study. Patients were categorized into 3 groups: those with (1) diabetes mellitus (DM), (2) MS without DM, and (3) no MS and no DM. MS was defined according to American Heart Association and National Heart, Lung, and Blood Institute criteria (the presence of > or =3 of the following criteria: obesity, hypertension, hypertriglyceridemia, low high-density lipoprotein cholesterol, and increased fasting glucose). Clinical follow-up was performed for > or =1 year (mean 27.5 +/- 18.1 months). One hundred sixty-four patients (22%) had DM, 180 patients (25%) had MS without DM, and 390 patients (53%) had no MS and no DM. Baseline clinical and angiographic parameters were comparable among the 3 groups, including lesion length and reference vessel diameter. In patients treated with bare-metal stents, the rates of major adverse cardiac events (MACEs) at 12 months were 14% in patients without DM or MS, 18% in those with MS but no DM, and 33% in those with DM (p = 0.046). In patients treated with sirolimus-eluting stents, the MACE rates were 3% in patients without DM or MS, 4% in those with MS, and 13% in those with DM (p = 0.034). DM (odds ratio 2.14, 95% confidence interval 1.48 to 3.07, p <0.001) and bare-metal stent (odds ratio 2.51, 95% confidence interval 1.49 to 4.22, p <0.001) implantation were independent predictors of MACEs during follow-up, whereas MS was not predictive. Similarly, MS was not a predictor of target lesion revascularization. In conclusion, patients with MS did not have an increased risk for target lesion revascularization or a greater MACE rate compared with control patients during a 12 month follow-up period after bare-metal or drug-eluting stent placement. In contrast, DM is associated with significantly increased event rates.

Impact of metabolic syndrome on clinical and angiographic outcome after sirolimus-eluting stent implantation.

BACKGROUND: Patients with metabolic syndrome (MetS) are at increased risk of cardiovascular events. The impact of MetS on clinical events and restenosis after drug-eluting stent placement is not well defined. METHODS: Two hundred and seventy-four consecutive patients with 298 de-novo coronary lesions (<50 mm lesion length, reference diameter<3.5 mm) successfully treated with sirolimus-eluting stents (SES) were enrolled in the study. Bifurcation lesions, left main lesions and ST-segment elevation myocardial infarcts were excluded. Patients were categorized into three groups: (i) diabetes, (ii) MetS without diabetes, (iii) controls without MetS or diabetes. MetS was defined as presence of > or =3 of the following criteria: obesity, hypertension, hypertriglyceridemia, low high-density lipoprotein cholesterol, raised fasting glucose. RESULTS: One hundred and twenty-one patients (44%) with 134 lesions had neither MetS nor diabetes, 84 patients (31%) with 89 lesions had MetS without diabetes and 69 patients (25%) with 75 lesions had diabetes. Baseline angiographic parameters were comparable between the three groups. Clinically driven target lesion revascularization rates and major adverse cardiac event rates at 12 months were 1, 1, 7% (P=0.039) and 3, 6 and 14% (P=0.032), respectively, for controls, patients with MetS/no diabetes and diabetic patients. Follow-up angiography at 6 months demonstrated late loss in lesion, which was 0.10+/-0.33 mm in the controls, 0.10+/-0.20 mm in patients with MetS/no diabetes and 0.36+/-0.66 mm in diabetic patients (P=0.009). CONCLUSION: MetS without diabetes does not result in an increase in target lesion revascularization, major adverse cardiac event rates or angiographic late loss compared with control patients after implantation of SES in de-novo coronary lesions.

Cardiac amyloidosis: MR imaging findings and T1 quantification, comparison with control subjects.

In cardiac amyloidosis an interstitial deposition of amyloid fibrils causes concentric thickening of the atrial and ventricular walls. We describe the results of tissue characterization of the myocardium by T1 quantification and MRI findings in a patient with cardiac amyloidosis. The T1 time of the myocardium was elevated compared to that in individuals without amyloidosis. The T1 time of the myocardium was 1387 +/- 63 msec (mean value obtained from four measurements +/- standard deviation [SD]) in the patient with cardiac amyloidosis, while the reference value obtained from the myocardium of 10 individuals without known myocardial disease was 1083 +/- 33 msec (mean value +/- SD). In combination with other MR findings suggestive of amyloidosis, such as homogeneous thickening of the ventricular and atrial walls, thickening of the valve leaflets, restrictive filling pattern, and reduction of systolic function, T1 quantification may increase diagnostic confidence.