A continuous metabolic syndrome score based on mixed principal component analysis in primary PCI patients

Abstract Background Metabolic syndrome (MetS) is a major risk factor for cardiovascular events after percutaneous coronary intervention (PCI). Continuous MetS (cMetS) scores may improve risk stratification compared to binary definitions, but their predictive value across age and sex groups remains unclear. Methods This retrospective cohort study analyzed 6060 patients undergoing primary PCI for STEMI. A cMetS score was derived using mixed principal component analysis from five MetS components. Patients were stratified by age (< 75 vs. ≥75 years) and sex and all resulting subgroups were analyzed separately. The primary outcome was one-year major adverse cardiovascular events (MACE). Associations were assessed using Cox regression with inverse probability weighting. Results The cMetS score effectively identified MetS (Area under the curve: 0.81–0.93). In patients < 75 years, the cMetS score was independently associated with one-year MACE in women (HR = 1.009 per point, 95% CI: 1.002–1.016) but not in men. A threshold of > 112 points identified high-risk women (adjusted HR = 1.748, 95% CI: 1.099–2.782). Binary MetS and the cMetS score did not predict MACE in either sex among patients aged ≥ 75. Conclusion In younger post-PCI patients, particularly women, our cMetS score independently predicts one-year MACE and can identify a high-risk subgroup. The prognostic significance of metabolic syndrome varies substantially by age and sex.