# Safety and Efficacy of Modern Stents in Patients with Metabolic Syndrome
## Materials and Methods
### Data Collection and Processing  
Our observational study used prospectively collected data of hospitalized patients who met all the following criteria: new diagnosed acute coronary syndrome, successful PCI revascularization procedure performed during hospital admission for the present ACS and metabolic syndrome.  
The diagnosis of ACS was made on symptoms of myocardial ischemia along with electrocardiographic changes and cardiac biomarker (high sensitive troponin I) status. Based on these findings, patients were further diagnosed with non-ST segment elevation myocardial infarction (NSTEMI), ST-elevation myocardial infarction (STEMI) or unstable angina (UA) according to 2020 ESC Guidelines criteria for ACS definition [19].  
The percutaneous coronary intervention was performed with standard methods. The drugs, type of devices, intervention techniques including stenting techniques and type of stents used during the percutaneous coronary procedure were determined by experienced operators. In coronary angiography, angiographic parameters were measured: location of the lesion, stenosis severity, thrombus, calcifications, and TIMI flow grade. More than 70% diameter stenosis of any coronary artery was considered significant disease. The type of stent used for implantation during the procedure were chosen according to the operator's decision or stent availability. Stents were chosen from BMS (Vision or Driver stent), first-generation DES (Sirolimus-eluting stent (SES)) or second-generation DES (Everolimus-eluting stent (EES), zotarolimus-eluting stent (ZES) and biolimus-eluting stent (BES)). According to this, patients were further divided into two large groups: first group included patients with 2 nd generation DES inserted and second group included patients with other stents implanted, such as 1 st generation DES and BMS. In patients with multiple stent implantation, the stent was implanted to the culprit lesion, or the more severe stenosis was taken into consideration.  
A successful percutaneous coronary intervention was defined as stent implantation in the most severe stenosis with a residual lesion under 30% and no major c-v complications,such as death, acute myocardial infarction, emergency coronary revascularization surgery or new angioplasty.  
Metabolic syndrome was defined, according The International Diabetes Federation (IDF) consensus, as central obesity (assumed at body mass index (BMI) over 30 kg/m\({}^{2}\)) and any two of the following criteria: hypertension (HTN): systolic blood pressure \(\geq\)130 or diastolic blood pressure \(\geq\)85 mm Hg, or treatment for previously diagnosed HTN, fasting plasma glucose over 100 mg/dL or previously diagnosed diabetes, raised triglycerides: \(>\)150 mg/dL, low HDL cholesterol: \(<\)40 mg/dL in males, \(<\)50 mg/dL in females, or treatment for these lipid abnormalities [20].  
Demographic characteristics including age, sex, body mass index, information on underlying diseases, patient clinical profile on emergency department presentation, laboratory tests, echocardiographic parameters and discharge guideline medication were recorded. Killip Kimball classification was assessed in each patient enrolled. The third class was considered equivalent to acute pulmonary edema and the last stage equivalent to cardiogenic shock.