Sastavnice metaboličkog sindroma kao nezavisni čimbenici rizika u bolesnika s akutnim koronarnim sindromom [Components of the metabolic syndrome as independent risk-factor in patients with acute coronary syndrome]

Kranjčec, Darko (2015) Sastavnice metaboličkog sindroma kao nezavisni čimbenici rizika u bolesnika s akutnim koronarnim sindromom [Components of the metabolic syndrome as independent risk-factor in patients with acute coronary syndrome]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Metabolic syndrome (MetS) is occurrence of diabetes mellitus/glucose intolerance and at least two of the following: arterial hypertension, central obesity, dyslipidemia and/or microalbuminuria in the same patient (definition by WHO). Aim of the study was to find out what is the occurrence of MetS and its components in patients with acute coronary syndrome. Furthermore, we compared size of myocardial infarction expressed in “peak-CK” and “peak-MB-CK” values as a “surrogate” for myocardial infarction size in patients with and without MetS. We also analyzed myocardial infarction size according to gender in groups with and without MetS. Then we analyzed influence of particular components of MetS on myocardial infarction size and heart failure. 230 patients with acute coronary syndrome admitted at coronary care unit of University hospital Dubrava between January 2006. and June 2007. were analysed. Patients admitted in subacute phase of myocardial infarction or those that did not give consent were not included in trial. Continuous variables were expressed as mean (M) and standard deviation (SD). Dichotomous variables were expressed as percentage. Student's t test was used to compare continuous variables, and Fisher's Exact Test was used to compare dichotomous variables. A p value <0.05 was considered to indicate statistical significance. Group of patients with MetS had larger myocardial infarction size expressed by “peak-CK” (p=0.003) and “peak-MB-CK” values (p=0.002). While in patients without MetS myocardial infarction size was larger in males, on the contrary, in MetS group myocardial infarction size was larger in females. Heart failure was also more often in MetS group (p=0.012), which was again more emphasized in females, however still not statistically significant. Rate of previous myocardial infarction was again higher in MetS group (p=0.027). Hospital mortality was higher in patients with metabolic syndrome. Conclussively, we can say that group of patients with MetS, especially females having acute coronary syndrome are proned to have more extensive myocardial infarction, are more proned to have heart failure, have had more often previous infarction and have higher hospital mortality.

Abstract in Croatian

Metabolički sindrom (MetS) je prema SZO istovremena prisutnost dijabetes melitusa/intolerancije glukoze te najmanje dviju od slijedećih sastavnica: arterijske hipertenzije, centralne pretilosti, dislipidemiji i/ili mikoralbuminurije. Cilj istraživanja bio je utvrditi učestalost MetS i njegovih sastavnica kod bolesnika s akutnim koronarnim sindromom. Nadalje htjela se usporediti težina akutnog infarkta miokarda mjerena vršnim vrijednostima CK i MB-CK kod bolesnika sa i bez MetS te usporediti težinu infarkta miokarda u muškaraca i žena sa i bez MetS. Analiziran je i utjecaj pojedinih sastavnica MetS na težinu infarkta miokarda i srčano popuštanje. U istraživanje je uključeno 230 bolesnika s akutnim koronarnim sindromom hospitaliziranih u koronarnoj jednici KB Dubrava od siječnja 2006. do lipnja 2007. godine. Bolesnici zaprimljeni u subakutnoj fazi infarkta miokarda te oni koji nisu dali pristanak nisu uključeni u istraživanje. Glede statističke obrade kontinuirane varijable su prikazane kao srednja (M) i standarna devijacija (SD). Dihotomne varijable su prikazane kao postotak. Studentov t test je upotrijebljen za komparaciju kontinuiranih varijabli, dok je Fischerov Exact Test uzet za komparaciju dihotomnih varijabli. Vrijednost p<0,05 se smatra statistički signifikantnom. Skupina bolesnika s MetS imala je opsežniji infarkt miokarda izražen u vršnim vrijednostima CK (p=0,003) i MB-CK (p= 0,002) nego skupina bez MetS. Dok je kod bolesnika bez MetS infarkt bio opsežniji u muškaraca u skupini s MetS infarkt miokarda bio je opsežniji u žena. Srčano popuštanje je također bilo prisutnije u bolesnika s MetS (p=0,012), što je ponovno bilo izraženije u žena, iako još ne u granicama statističke značajnosti. Stopa ponovljenog infarkta miokarda bila je češća u bolesnika sa MetS (p=0,027) kao i bolnička smrtnost. Zaključno možemo reći da je skupina bolesnika s MetS, posebice žena s akutnim koronarnim sindromom predisponirana k opsežnijem infarktu miokarda, srčanom popuštanju, ponovljenom infarktu miokarda i bolničkoj smrtnosti.

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