Eruvaram Srikanth1, Ravi Srinivas2, Adikesava Naidu Otikunta3, Y. V. Subba Reddy4
BACKGROUND
Coronary artery disease has a major share for cardiovascular disease in a developing country like India, which is in epidemic
proportion. There are number of risk factors for development of coronary artery disease. According to INTERHEART study,
there were 9 modifiable risk factors with population attributable risk of 90 percent in men and 94 percent in women. Metabolic
syndrome cluster of risk factors, which include insulin resistance, subclinical inflammation, increased future risk of diabetes and
coronary artery disease. In south Asian people are increased tendency to develop metabolic syndrome because of their high
percentage of body fat, abdominal obesity and insulin resistance. Metabolic syndrome has more mortality and morbidity from
CAD. It is desirable identifying this subset of patients, which could improve patient or physician adherence to risk-reducing
behaviours or interventions and improve clinical outcomes. There are reports in literature on association inflammatory markers
and insulin resistance with severity of disease in CAD. There are few studies, which correlated severity of CAD with SYNTAX
score in patients with metabolic syndrome, so in these study prospectively evaluated clinical and angiographic profile in patients
with CAD in subset patients with metabolic syndrome, CAD severity was assessed with SYNTAX scoring system and thrombus
burden was evaluated.
MATERIALS AND METHODS
Among 101 patients who were diagnosed to have metabolic syndrome according to ATP III guidelines were evaluated in the
study. All patients were evaluated by clinical examination including waist circumference, body mass index, routine blood
investigations were carried out. Lipid profile, ECG and 2D echo was done. Then, patients were evaluated with coronary
angiogram and among patients who underwent coronary angiography, the lesions were classified according to AHA/ACC
classification into type A, type B and type C for assessing lesion complexity. Syntax score was calculated and along with
thrombus burden was assessed by TIMI thrombus grading.
RESULTS
A total of 101 patients were included in the study from 2013 January to 2015 December. Of total cohorts, males were 70
(69.3%, n=70) and female were 31 (30.7%, n=31). The mean age of the studied population was 48.96±10.1 SD years. The
clinical profile of the patients with the metabolic syndrome patients who satisfied 3 out of 5 criteria were 24.75% (n=25), who
satisfied 4 out of 5 criteria were 48.51% (n=49) and patients who satisfied 5 out of 5 criteria were 26.73% (n=27), respectively.
In the present study, there was 47.46% (n=28) of myocardial infarction patients were thrombolysed and remaining 52.54%
(n=32) were not thrombolysed. The thrombolytic agent, which was used in 82.14% (n=23) was streptokinase and in 17.86%
(n=5) the thrombolytic used was tenecteplase. Among the patients who underwent coronary angiogram, 92 patients were
having coronary artery disease and remaining 7 patients had normal epicardial coronary artery disease (92.1% vs. 6.9%),
about 71% (n=5) of patients in the normal epicardial coronary group were females. The coronary artery lesions when assessed
by the AHA/ACC classification, most of the lesions were type B lesions 41.6% (n=46) followed by type A lesions 25.7% (n=26)
and type C lesions 14.8% (n=15). Total 93 patients with coronary disease with metabolic syndrome, 7.9% (n=8) patients had
grade V thrombus followed by 4.9% (n=5) who had grade I, 2.97% (n=3) had grade III and 1% (n=1) each had grade II and
grade IV, respectively. The mean syntax score in patients with metabolic syndrome with diabetes was 11.4±7.5 SD and the
mean syntax score in the patients with metabolic syndrome without diabetes was 8.6±5.5 SD.
CONCLUSION
In present study in which patients with metabolic syndrome with coronary artery disease were evaluated prospectively with
mean age of 48.96±10 years, smoking (p<0.001) and alcohol consumption (p<0.05) were more in male gender, hypertension
was more in the female gender, diabetes was equal in both genders. Coronary angiogram showed more single vessel
involvement in both genders, more of type B lesions. Mean syntax score in patients with metabolic syndrome with diabetes
was higher when compared with metabolic syndrome without diabetes, although it was not statistically significant (11.4±7.5
vs. 8.6±5.5, p>0.05), metabolic syndrome with coronary artery disease had low mean HDL (29±8.49 mg%, mean high
triglyceride 189±124.45 mg%), mean high blood pressure (140/90 mm of Hg, mean), in both genders.
