Which method is superior in predicting the severity and extent of coronary artery disease: metabolic syndrome NCEP-ATP III criteria or MS score?

OBJECTIVES
Definition of metabolic syndrome (MS) was made according to the NCEP-ATP III criteria and the new MS scoring system developed by Macchia et al., and the role of each method was assessed in predicting the severity and extent of coronary artery disease (CAD).

STUDY DESIGN
The study included 158 patients (103 males, 55 females) who underwent coronary angiography for CAD. Metabolic syndrome was identified according to both the NCEP-ATP III criteria and the MS score. MS scores were calculated by summing all the points rated for sex, age, body mass index, hypertension, and levels of HDL-cholesterol, triglyceride, and fasting glucose. The severity and extent of CAD were evaluated by the Gensini score. Patients were classified as having severe (≥20, n=69) or mild (<20, n=89) CAD according to the Gensini scores, and by high (≥27.5, n=103) and low (<27.5, n=55) MS scores, depending on the optimal cut-off point by ROC analysis.

RESULTS
The mean MS score was significantly higher in patients having severe CAD than those having mild disease (p<0.001). However, these two groups did not differ significantly with respect to the number of patients diagnosed as having MS according to the NCEP-ATP III criteria and parameters thereof other than glucose and triglyceride levels. The Gensini score was significantly higher in patients having a MS score of ≥27.5 (p=0.001). There was a moderate correlation between the MS score and the severity and extent of CAD (r=0.347; p<0.001). Multivariate logistic regression analysis revealed that the MS score was the only independent factor that significantly increased the severity and extent of CAD by 3.4 times (p=0.012; %95 confidence interval: 1.3-8.9).

CONCLUSION
The MS score may be a better predictor of metabolic risk in MS patients than the NCEP-ATP III criteria. Patients with a high MS score are more likely to develop severe CAD.