DOI: https://doi.org/10.53350/pjmhs22163372 ORIGINAL ARTICLE 372 P J M H S Vol. 16, No. 03, MAR 2022 Frequency of in-Hospital Mortality in Acute Myocardial Infarction Patients with Metabolic Syndrome SHAHBAZ ALI SHAH 1 , UZAIR ABBAS 2 , NAVEED AHMED SHAIKH 3 , MIR FAHAD HUSSAIN TALPUR 4 , KAMRAN NADEEM 5 , SALIK AHMED 6 1,3-6 Post FCPS Fellow of Intervention Cardiology, National Institute of Cardiovascular Diseases (NICVD) Karachi, Pakistan 2 Assistant Professor of Physiology, Dow university of Health Sciences, Karachi, Pakistan Correspondence to: Uzair Abbas, Email: uzair.abbas@duhs.edu.pk, Cell: 0300-3280080 ABSTRACT Background: Metabolic syndrome is one of the major public health issues worldwide. It is a pattern of physical conditions and metabolic abnormalities, commonly occurring together and increases an individual's risk of developing type 2 diabetes mellitus and atherosclerotic cardiovascular disease. Aim: To determine the frequency of in hospital mortality and in acute myocardial infarction patients with metabolic syndrome and its association with components of metabolic syndrome. Study Design: Prospective cross-sectional study Place and Duration of Study: National Institute of Cardiovascular Diseases (NICVD), Karachi from 1 st May 2019 to 31 st December 2020. Methodology: Two hundred and ten patients with acute myocardial infarction were taken and assessed for metabolic syndrome. Participants of either gender having age 18-70 years were included in the study. Demographic, clinical characteristics and in-hospital mortality were recorded. Results: Mean age of the participants was 55.68±7.81 years. Total 88 (~41%) were female and 122 (~58%) were male. Thirty two (15.2%) participants had in-hospital mortality. Moreover, the in-hospital mortality was associated with higher age, waist circumference, and high triglyceride levels with p values <0.05. Conclusions: The waist circumference and high triglyceride component of metabolic syndrome were found to be associated with high mortality in patients who presented with acute myocardial infarction. It is essential therefore for focus on these modifiable risk factors associated with higher mortality as a secondary prevention strategy. Keywords: In-hospital mortality, Cardiovascular diseases, Metabolic syndrome, Myocardial infarction INTRODUCTION Myocardial infarction (MI) is one of the leading cause of mortality worldwide 1 which results due to pre-existing atherosclerotic lesions followed by local plaque disruption. 2 Atherosclerosis is defined as deposition of plaques formation in the coronary artries. 3-7 Knowing and preventing the pathophysiology of conditions that increase the risk of MI may help attenuate the progression of atherosclerotic vascular disorders leading to MI. 8,9 Metabolic syndrome increases the chances of death up to double in patients with cardiovascular disease and chances of stroke of MI is three times higher as compared to normal persons. 10-14 Reported frequency of metabolic syndrome in atherosclerosis patients is ~50% and its prevalence was observed higher among females. 15-17 Lifestyle modifications, physical activity and exercise, taking good balanced diet can minimize the related complications present with metabolic syndrome. 18-20 Diabetes mellitus further worsen the condition and onset of CVD in metabolic syndrome patients is higher upto 1.5 to 3-folds. Conversely, another study documented that, prevalence of metabolic syndrome was higher in man (34%) in contrast to women (16%). 21 It was found that higher prevalence of ischemic strokes in MetS as compared to diabetics alone in which it was reported that prevalence was higher in metabolic syndrome participants (19%) than to diabetic patients (7%). Increased risk of peripheral vascular disease has also been observed in metabolic syndrome patients. 22-23 The higher mortality rate in patients with MetS and AMI was found. Among several components of MetS, different components are found to have impact on prognosis and outcome of the disease. The purpose of this study is to measure the prevalence of mortality rate among patients who had metabolic syndrome and myocardial infarction and identify the risk factors associated with higher mortality in these patients. MATERIALS AND METHODS This descriptive cross-sectional study conducted at National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan. Patients within age group of 18-70 years, diagnosed with Acute Myocardial Infarction (AMI) and of either gender were included in the study. Written and informed consent was obtained from patients or family member in case patient was unable to approach due to medical condition prohibiting timely approach of research team. With an estimated 5% margins of type 1 error (level of significance 0.5) and 95% confidence interval an approximate, sample size of 210 was calculated. Demographic and clinical characteristics were recorded. For MetS, we recorded serum triglyceride concentration, blood pressure, waist circumference, fasting plasma glucose level and lipoprotein-cholesterol (HDL-C) level. Abdominal obesity was defined as waist circumference ≥ 102 cm for males and ≥88 cm for females, while high serum triglyceride levels were taken ≥150 mg/dl and serum HDL levels were taken <40 mg/dl for males (<50 mg/dl for females). Hypertension was defined as blood pressure measuring ≥130/85 mmHg and diabetes were defined as FBS ≥110 mg/dl. All the patients were followed by research team during the index hospitalization and in-hospital mortality was recorded. Data was entered and analyzed using SPSS-21.Effect modifiers like age groups, gender, smoking status, and five metabolic syndrome (MetS) criteria were compared through stratification. Post stratification chi-square test or fisher exact test was applied. Two-sided p-value of ≤0.05 was taken as criteria of statistical significance. RESULTS There were 122 (58.1%) males and 88 (41.9%) females with mean age was 56.78±7.81 years. Eighty four (40%) were found to be smokers.134 (63.8%) had abdominal obesity and high blood pressure was found in 92 (43.8%) participants. High blood glucose was found in 112 (53.3%) while high triglyceride levels were observed in 134 (63.8%). Frequency distribution of low HDL showed that out of 210 patients, 102 (48.6%) had low HDL levels (Table 1). There were 32 (15.2%) participants had in-hospital mortality. According to age with respect to in-hospital mortality showed that 6 (18.8%), 16 (50%) and 10 (31.2%) patients who were in age group 18-40 years, 41-60 years and 61-70 years had in-hospital mortality respectively with P-value of 0.03, for gender showed 18 (56.2%)