Background The prevalence of the cardiovascular risk factors is growing. The effect of the metabolic syndrome on outcomes in patients with preexisting CAD has not been well studied. This study was conducted to assess the prevalence, characteristics, in-hospital and long term prognosis of CAD with metabolic syndrome, and to determine which factor that influencing the CAD prognosis most.

Methods The DESIRE (Drug-Eluting Stent Impact on Revascularization) registry represents a database of 2368 patients with coronary artery disease (CAD) between Jul, 2003 and Sep, 2004. Media long-term follow-up was 3.5 years (293–1855 days). Metabolic syndrome was based on modified the Adult Treatment Panel (ATP) III Definition of the Metabolic Syndrome in 2005, using body mass index (BMI) instead of waist circumference. We tested the ability of MS and its components to predict the incidence of major adverse cardiac and cerebral events (MACCE) in a large cohort of patients undergoing revascularization.

Results Presence of MACCE was predicted only by MS (adjusted OR (OR)=1.319, 95% CI 1.020 to 1.706, p=0.035) but not other risk factors of cardiovascular (such as elder, male, smoking, high LDL cholesterol, CAD family history). MS was present in 45.6% (high FG 44.5%; high TG 45.0%; low HDL 50.8%; high BP 61.4%; high BMI 60.7%). After follow-up in 3.5 years, the ratio of MACCE in CAD with metabolic syndrome patients increased significantly (18.9% vs 15.6%, p=0.036). In multivariable model of five factors of MS, MACCE was predicted by high FG (fasting glucose) (OR=1.047, CI 1.005 to 1.091) and low HDL (OR=0.777, CI 0.610 to 0.989). MS confers a higher risk of long-term MACCE in CAD patients with (OR=1.258, CI 1.010 to 1.607) or without diabetes (OR=1.139, CI 1.004 to 1.505).

Conclusions The metabolic syndrome has primary predictive ability for MACCE in CAD patients, carried primarily by high FG and low HDL. MS confers a higher risk of long-term MACCE in CAD patients with or without diabetes.