Risk Of Major Adverse Cardiovascular Events In Patients With Metabolic Syndrome After Revascularization: A Meta-analysis Of Eighteen Cohorts With 18457 Patients

Background: Metabolic syndrome(Met S) is a cluster of cardiovascular risk factors and often correlated with a high prevalence of diabetes mellitus(DM). The effective therapeutic way of coronary artery disease(CAD) is coronary revascularization. However, the effect of Met S on the prognosis of CAD patients undergoing revascularization remains unclear. Therefore, we performed current meta-analysis to provide a comprehensive evaluation of the association between Met S and major adverse cardiovascular events(MACE) and to clarify the effect of revascularization methods among them in patients with CAD undergoing successful revascularization.Methods: Pub Med and Embase databases were searched. Cohort studies evaluating the association between Met S and risk of MACE and providing the hazard ratio(HR) with 95% confidence interval(CI) or sufficient data to calculate HR and its 95%CI among patients after revascularization were included. The pooled estimates were performed by using a random-effects model despite heterogeneity. Subgroup and sensitivity analyses were also conducted adherence to guidelines. Additionally, publication bias was evaluated with funnel plots and Egger’s test. The primary outcome is risk of MACE, and the secondary outcome is all-cause mortality.Results: Eighteen trials with 18457 patients were included. Overall, Met S was associated with significant increased risks of MACE(HR 1.47, 95%CI 1.26- 1.72, I2 = 46.4%, PH = 0.016, P <0.001) and all-cause mortality(HR 1.58, 95%CI 1.29- 1.92, I2 = 45.6%, PH = 0.075, P <0.001) in CAD patients received revascularization. The results remained stable and robust in our subgroup analysis and sensitivity analysis. In additional sensitivity analysis according to DM, the pooled results suggested that Met S could also significantly increase the risk of MACE(HR 2.12 95%CI 1.53- 2.95, I2 = 0, PH = 0.929, P <0.001) and all-cause mortality(HR 1.28 95%CI 1.02-1.61, I2 = 0, PH = 0.577, P = 0.03). While sensitivity analysis according to revascularization way, no significant increased risk of MACE(coronary artery bypass graft(CABG): HR 1.31 95%CI 0.81- 2.11, I2 = 74.8%, PH = 0.019, P = 0.275; drug-eluting stent(DES): HR 1.12 95%CI 0.57- 2.21, I2 = 73.9%, PH = 0.004, P = 0.739) or all-cause mortality(CABG: HR 1.36 95%CI 0.84- 2.21, I2 = 82.3%, PH = 0.004, P = 0.213; DES: HR 1.43 95%CI 0.81-2.52, I2 =76.3%, PH = 0.015, P = 0.223) was found in patients undergoing CABG or DES in the sensitivity analysis. For the primary outcome of MACE, no potential publication bias among the included studies was identified by funnel plots and Egger’s test(P = 0.202).Conclusion: Met S was associated with increased risks of MACE and all-cause mortality in patients after revascularization, including patients without DM, but not in patients receiving CABG or DES. Therefore, prevention and treatment of Met S are extremely necessary in patients undergoing revascularization. Moreover, CABG and DES should be recommended for CAD patients with Met S and future researches are still warranted.