Associations Between Metabolic Syndrome and Long-Term Mortality in Patients who underwent Percutaneous Coronary Intervention: An Australian Cohort Analysis.

Metabolic syndrome (MetS) provides significant risk for coronary disease, however long-term prognosis after percutaneous coronary intervention (PCI) has been understudied. We assessed the prevalence and outcomes of patients with MetS from an Australian PCI cohort. We retrospectively examined data from the Melbourne Interventional Group multicenter PCI registry using a modified definition for MetS including ≥3 of the following: hypertension, diabetes mellitus, dyslipidemia, and body mass index ≥30 kg/m2. Thirty-day outcomes and long-term mortality were compared with patients without MetS. Cox regression methods were used to assess the multivariable effect of MetS on long-term mortality. Of 41,146 patients, 12,228 (34%) had MetS. Patients with MetS experienced greater 30-day myocardial infarction (2.2% vs 1.8%, p = 0.013), whereas patients without MetS had a trend for greater 30-day mortality (3.0% vs 3.4%, p = 0.051) and greater in-hospital major bleeding (1.7% vs 2.4%, p <0.001). After a median follow-up of 5.62 years (Q1 2.03, Q3 8.89), patients with MetS experienced greater mortality (24% vs 19%, p <0.001). After adjustment, MetS was not an independent predictor of long-term mortality (hazard ratio 0.95 confidence interval 0.86 to 1.05, p = 0.35). In sensitivity analyses, MetS-Diabetic patients had the highest, and MetS-NonDiabetic obese patients had the lowest long-term mortality. One in 3 patients who underwent all-comer PCI presented with MetS and experienced greater long-term mortality compared with others. However, this association was lost after adjustment for baseline confounders, highlighting that MetS is a marker of risk after PCI. Our findings support the obesity paradox and confirm robust associations between diabetes mellitus and long-term mortality.

Associations between Dual Anti-Platelet Therapy score and long-term mortality after percutaneous coronary intervention: Analysis of >27,000 patients.

BACKGROUND: The dual antiplatelet therapy (DAPT) score was developed to identify patients undergoing percutaneous coronary intervention (PCI) who are likely to derive benefit (score ≥2) or harm (score <2) from extended DAPT beyond 1-year post-PCI with respect to ischaemic and bleeding outcomes. We examined the associations between DAPT score at index PCI and long-term mortality from an all-comers PCI registry in patients receiving DAPT as per the standard of care. METHODS: We retrospectively examined prospectively collected data from the Melbourne Interventional Group PCI database (2005- 2018) and grouped patients as having DAPT score ≥2 or <2. Long-term mortality was assessed from the Australian National Death Index linkage. The primary endpoint was long-term mortality using survival analysis. Secondary endpoints included in-hospital events and 30-day major adverse cardiac events (MACE), a composite of death, myocardial infarction, or target vessel revascularization. RESULTS: Of 27,740 study patients, 9,402 (33.9%) had DAPT score ≥2. Patients with DAPT score ≥2 were younger and included more females with higher prevalence of cardiovascular risk factors. Patients with DAPT score ≥2 had higher in-hospital mortality (3.0% vs. 1.0%) and major bleeding (2.3% vs. 1.6%), 30-day MACE (7.1% vs. 3.1%), and long-term mortality at a median follow-up of 5.17 years (21.9% vs. 16.5%), p<0.001 for all. CONCLUSION: A third of all-comer patients undergoing PCI had a DAPT score ≥2 with greater short-term ischaemic and bleeding risk, and higher long-term mortality. Risk assessment using the DAPT score may guide the duration and intensity of DAPT beyond the early post-PCI period.