Prognostic value of the Metabolic Score for Insulin Resistance in the development of myocardial infarction in patients with coronary artery disease and obesity after coronary stenting

Abstract

Aim. To assess the predictive value of anthropometric indices in relation to the risk of myocardial infarction in patients with coronary artery disease (CAD) and obesity after coronary stenting.Material and methods. The study included 229 patients with class II-IV angina pectoris, hospitalized for elective percutaneous coronary intervention with stenting. The median age was 55±7,5 years. Depending on the presence of obesity according to the World Health Organization criteria (1999), patients were divided into 2 groups. Group 1 included 107 obese patients, while group 2 — 122 non-obese patients. Patients were measured waist circumference (WC) and hip circumference (HC). In addition, waist-to-hip ratio was assessed. Lipid spectrum parameters were determined (total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C). The following indices were calculated: body mass index, visceral adiposity index, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), Metabolic Score for Insulin Resistance (METS-IR), TG-glucose index, lipid accumulation product, TG/HDL-C ratio, and metabolic index.Results. In the group of patients with obesity, higher values of cholesterol (p<0,001), TG (p<0,001), LDL-C (p=0,006), and lower HDL-C (p<0,001) levels were established. Comparative analysis of metabolic indices showed that all indices significantly differed in both groups. In order to determine the critical values for quantitative predictors, ROC curves were constructed with the determination of threshold values that increase the likelihood of myocardial infarction after revascularization. It has been shown that only the METS-IR has prognostic significance. It was found that the METS-IR >48,16 is a predictor of myocardial infarction in patients with CAD and obesity (area under the ROC curve, 0,653, sensitivity — 75%, specificity — 64,39%; 95% confidence interval: 0,587-0,716; p=0,045).Conclusion. In our study, we demonstrated the significance of the novel METS-IR. We found that the value of METS-IR >48,16 is a predictor of myocardial infarction in patients with CAD and obesity after coronary revascularization (area under the ROC curve, 0,653, sensitivity — 75%, specificity — 64,39%).