The aim of this study is to evaluate the impact of metabolic syndrome (MetS) on clinical severity and long-term prognosis in patients with myocardial infarction with ST-segment elevation (STEMI). We examined 507 patients with STEMI, who were admitted for primary percutaneous coronary intervention classified according to the presence of MetS using American Heart Association and the National Heart, Lung, and Blood Institute definition. After applying these criteria, the patients were categorized into groups as patients with MetS and without MetS. We compared baseline characteristics, clinical findings, and outcomes between these groups. During the 48-month follow-up, we collected data about major adverse cardiac events (MACE) and mortality. The MetS group comprised 217 patients with MetS (mean age = 60.71 ± 11.52 years; 59 females), while the control group comprised 290 subjects (mean age = 57.50 ± 10.95 years; 54 females). The patients with and without MetS had similar parameters of clinical severity of STEMI but differed in severe coronary artery disease. During the follow-up period, a significantly higher percentage of myocardial infarction (6.91% vs 2.06%) and new revascularization (16.59% vs 8.97%) was recorded in the MetS group. On multivariate analysis, MetS was independently associated with MACE (HR = 1.834, 95% CI = 1.162-2.896, p = 0.009) but not with mortality (HR = 1.603, 95% CI = 0.864-2.973, p = 0.134). Among cardiovascular events that compose MACE, MetS was associated with new revascularization (HR = 2.204, 95% CI = 1.273-3.815, p=0.005). The presence of MetS in patients with STEMI is an independent risk factor for MACE, and this syndrome is strongly associated with new revascularization.

Background and objectives: A long-term therapeutic strategy in hypertensive patients equally depends on measured arterial blood pressure values and total determined cardiovascular risk. The aim of the adequate hypertensive patient treatment is both the reduction in arterial blood pressure and the reduction of all preexisting modifiable risk factors, prevention of target organs damage, and adverse cardiovascular events. The aim of this study was to determine independent predictors of cardiovascular events in patients with hypertension and high cardiovascular (CV) risk, and whether the modifiable risk factors could affect long-term prognosis in the studied population. Materials and Methods: This prospective study included 142 hypertensive patients (65% females), mean age 63.1±8 years, with high CV risk. Each participant was followed for 6.2 years. Results: During the follow-up period, the incidence of non-fatal and fatal CV events was 19.7%, CV mortality 7%, and total mortality 9.9%. Our multivariate analysis showed that plaques in both carotid arteries (p = 0.042), diabetes mellitus (p = 0.042) and cholesterol at the beginning of the study (p = 0.016) were significantly associated with an increased risk of CV events. Patients’ age (p = 0.009), intima-media thickness (p = 0.001) and diabetes mellitus (p = 0.042) were significantly associated with an increased risk of CV mortality, and age (p = 0.007) and cholesterol (p = 0.002) were independent variables significantly associated with increased total mortality rates. Conclusions: The results of the present study showed that the main predictors of adverse CV events in high-risk hypertensive patients were years of age, cholesterol levels, diabetes, intima-media thickness, and carotid arteries plaques.

Objectives: We sought to determine the predictive power of metabolic syndrome (MS) definitions on the prognosis in patients with myocardial infarction with ST-segment elevation (STEMI). Methods: We prospectively included 507 patients with STEMI who were admitted for primary percutaneous coronary intervention and could be identified for MS using the AHA-NHLBI, NCEP-ATP III and IDF definitions. After applying these criteria, we divided the group in patients with MS and without MS; we compared baseline characteristics, clinical findings and outcomes among these patients. Results: The prevalence of MS was lowest with the NCEP-ATP III definition (37.87%), followed by the AHA-NHLBI definition (42.80%) and highest when using the IDF definition (44.38%). During follow-up, the occurrence of new myocardial infarction and new revascularization was significantly higher in patients with MS. Only in a group of patients with MS according to the NCEP-ATP III definition, a higher number of strokes were recorded. Multivariate analysis shows that MS according to the NCEP-ATP III definition was an independent predictor for MACE (OR 1.830, 95% CI 1.238–2.704, p = .002) but not for mortality. Conclusion: Metabolic syndrome according to the NCEP-ATP III definition was associated with increased risk of the development of new cardiovascular events among the patients with STEMI.

Background/Aim. Health-related quality of life (HRQoL) is an important indicator of patient condition following myocardial infarction. It may serve as a predictor of mortality and new hospitalization. The aim of this study was to evaluate the association of selected sociodemographic and clinical characteristics with HRQoL in the Serbian cohort of patients with myocardial infarction with ST segment elevation (STEMI) that were treated with primary percutaneous coronary intervention (pPCI). Methods. Patients were recruited from the population of patients with STEMI who were hospitalized in the Clinical Center of Serbia in Belgrade, between 1st December, 2009 and 30th June, 2010. The study was conducted among 507 STEMI patients treated with pPCI. The HRQoL was assessed using the Questionnaire Short Form Health Survey (SF-36). Multivariate logistic regression models were used for each components score in order to determine independent predictors of HRQoL. Results. The patients with the lowest tertiles of Physical component score (PCS) and the Mental component summary score (MCS) were older, likely to be females, unpartnered, with a poor economic status, with diabetes, with prior myocardial infarction and with more extensive coronary artery disease. There were more employed and the individuals with smoking history in the group of patients with the higher scores. The characteristics of patients with lower PCS score were: the higher presence of hypertension, prior cerebrovascular insult and left anterior descending artery as infarct artery. This study demonstrated that HRQoL was significantly associated with patient?s age, gender, diabetes mellitus, a poor way of living and loneliness. Furthermore, the presence of previous cerebrovascular insult seems to affect the physical component score. Conclusion. Knowledge of predictors of HRQoL in the STEMI patients may provide indications for optimal treatment and anticipate their impact on the treatment outcome.

Background/Objectives: Metabolic syndrome (MetS) affects more than 1.5 billion adults worldwide and is present in 37–70% of STEMI patients. Its ten-year prognostic value after primary PCI—particularly for heart failure, which is rarely examined as a primary endpoint—remains incompletely characterized. Methods: In total, 506 STEMI patients treated with primary PCI (December 2009–June 2010) were followed for ten years. MetS was defined at admission using AHA/NHLBI criteria. Co-primary endpoints were all-cause mortality, MACE, and hospitalization for heart failure. Multivariable Cox regression was adjusted for sex, age, LVEF, previous MI, Killip class, and multivessel disease. Four ML models were evaluated by 10-fold stratified cross-validation with SHAP-based feature, with a Fine–Gray subdistribution-hazard sensitivity analysis for heart failure. Feature attribution used TreeSHAP on XGBoost and permutation importance on a Random Survival Forest. Results: MetS(+) patients were older, more frequently female, and had higher SYNTAX scores (all p < 0.05). MetS was present in 216 patients (42.7%). It did not independently predict mortality (HR 1.09, p = 0.66) but did predict MACE (HR 1.47, p = 0.028) and heart failure hospitalization (cause-specific HR 2.86, 95% CI 1.57–5.22; Fine–Gray HR 2.61, 95% CI 1.44–4.75; both p ≤ 0.002). The null mortality finding coincided with differential statin discontinuation and a selective obesity paradox: in non-obese patients, MetS doubled mortality (42.9% vs. 21.1%, p = 0.008), while in obese patients, the effect disappeared (26.5% vs. 23.2%, p = 0.529). Two independent ML frameworks ranked the cumulative number of MetS criteria—rather than the binary diagnosis—among the leading individual-level features for heart failure prediction (Random Survival Forest c-index 0.843). Conclusions: In primary PCI-treated STEMI survivors, MetS independently predicts ten-year MACE and heart failure but not mortality. The number of MetS criteria at baseline, rather than the binary classification, was more strongly associated with heart failure risk; whether prospective modification of individual components reduces this risk requires dedicated interventional studies. The lean MetS-positive phenotype may represent a candidate subgroup warranting further investigation.