# Safety and Efficacy of Modern Stents in Patients with Metabolic Syndrome
## 4 Discussion  
MS is a major public health problem of the 21 st century. MS was previously associated with an increased risk of coronary artery disease and c-v mortality. However, the impact of metabolic syndrome on stent performance in patients undergoing PCI is not yet clear. Moreover, there are few data on the influence of MS on the performance of different stent types in acute and real-life setting. Various factors can be responsible for stent failure, starting with stent characteristics and ending with the patient's response to stent injury. The possible mechanisms were related to mechanical factors (nonuniform stent strut distribution, stent underexpansion, stent fracture, nonuniform drug elution), technical factors (stent gap, barotrauma outside stented segment, residual uncovered atherosclerotic plaques) and biological factors (hypersensitivity, drug resistance) [21; 22; 23; 24]. In addition, the individual's response to stent placement is also decisive when it comes to evaluating the risk of restenosis. MS encompasses many risk factors for in-stent restenosis, and diabetes was specifically identified as a powerful determinant of neointimal hyperplasia [25; 26]. This prospective follow-up study provides information on descriptive epidemiology, angiographic characteristics and outcomes of MS patients presenting with ACS to our specialized cardiac center. Furthermore, a comparative analysis of subjects with MS was made according to different types of stent used in patient's angioplasty. We observed similar demographic profiles to the prior reports, in terms of mean age and gender preponderance of metabolic syndrome patients presenting with ACS [27]. Patients with 2 nd generation DES stenting were 2 years younger than patients with other stents implanted and the prevalence of MS in male patients presenting with ACS was higher when compared with overall cohort, regardless of the stent type. Among the individual components of MS, raised blood pressure and low HDL-C were more common, besides central obesity, which was the main criteria for MS definition used in our study. A higher prevalence of diabetes (40.19%) was seen in our study when compared with prior studies (29.4-40%) [28; 29]. Most patients had three or four MS factors; meanwhile, quintuple association comprising all five MS components (BMI > 30 kg/m\({}^{2}\) + HTN + HTg + HDLc + DM) was most frequent in patients with other stents than 2 nd generation DES inserted (18.86% vs. 17.21%). Prior studies have shown that MS does not increase c-v risk more than the sum of its components [30; 31]. According to this, our study recorded worse outcomes in terms of cardiac mortality in patients with other stents implanted, but no statistically significant differences were observed in terms of MACE or TLRs when comparing to the 2 nd generation DES group. These results suggest that the number of MS components is not as important as their individual atherogenic effect. Figure 1: Leading causes of cardiac deaths in patients according to stent type inserted. As other studies showed [32], the prevalence of multi-vessel disease was overall greater in MS patients compared to single vessel disease (58.82% vs. 41.18%). This demonstrates the strong association between MS and coronary artery disease. When comparing patients according to stent type implanted, multi-vessel disease was predominant in patients with 2 nd generation DES inserted (62.91%), whereas similar percentages of single and multi-vessel disease were observed in patients with other stents implanted. In contrast, complex coronary lesions defined by severe stenosis, total occlusion, type C lesion along with acute thrombus, excepting ostial lesion, were more frequently seen in patients undergoing PCI with 1 st generation DES or bare metal stenting than in patients with second-generation stent placement. However, patients having ostial lesions were more likely to undergo 2 nd generation DES stenting.