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Comparing the predictive abilities of different metabolic syndrome definitions for acute coronary syndrome: a case-control study in Chinese adults.

BACKGROUND
Different institutions have proposed various definitions for metabolic syndrome, which is a combination of risk factors for cardiovascular diseases (CVD). This study aimed to compare the feasibilities and abilities of different metabolic syndrome definitions in predicting acute coronary syndrome (ACS) in Chinese adults.


METHODS
A case-control study was designed. This study recruited 162 newly diagnosed ACS patients (the case group) and 162 non-ACS patients (the control group) according to the study criteria. Metabolic syndrome definitions proposed by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), International Diabetes Federation (IDF), American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI), Chinese Diabetes Society (CDS), and Joint Committee for Developing Chinese Guidelines on Dyslipidemia in Adults (JCDCG) were studied. After collecting demographic and clinical data, sensitivity, specificity, positive and negative predictive values (PPV, NPV), the likelihood ratio of a positive test and a negative test (LR+, LR-), odds ratios (OR), diagnostic accuracy, and the Youden index (YI) were compared.


RESULTS
Of the 324 participants, the mean age was 59.1 ± 10.5 years, and 56.8% were males. The AHA/NHLBI and IDF definitions had better sensitivity (53.09%, 48.77%). The CDS definition was more specific (76.54%), but less sensitive (25.93%). The IDF definition performed better in PPV (53.74%), NPV (53.11%), LR+ (1.15) and LR- (0.89), OR (1.32), and diagnostic accuracy (53.4%). The IDF definition also provided optimal cutoff points with the biggest YI.


CONCLUSION
The IDF definition performed better in detecting the onsets of nonfatal ACS in the northwestern Chinese population. All studied definitions were feasible in Chinese clinical settings.