Patients with metabolic syndrome (MetS) are at higher risk of myocardial infarction after undergoing percutaneous nephrolithotomy (PCNL), according to a new study.

“Routine preoperative cardiac testing may benefit this population before PCNL,” investigators concluded in a paper published in the Journal of Endourology.

MetS is a constellation of conditions, including hypertension, diabetes mellitus, dyslipidemia, and obesity.

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Using the Healthcare Cost and Utilization Project State Inpatient Database for Florida and California, Carrie E. Johans, MD, of Loyola University Medical Center in Maywood, Illinois, and colleagues identified 39,868 patients who underwent percutaneous nephrolithotomy for upper urinary tract stones. Of these, 19,268 (48.3%) and 2668 (6.7%) had 1–2 and 3–4 MetS conditions, respectively. The remaining 17,932 (45%) had no MetS conditions.

The incidence of postoperative myocardial infarction (MI) increased from 0.6% of patients with no MetS conditions, 1.0% of those with 1–2 MetS conditions, and 1.8% of those with 3–4 MetS conditions, Dr Johans’ team reported.

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On multivariate analysis, patients with 3–4 MetS conditions had significant 2.2-fold increased odds of postoperative MI compared with those who had no MetS conditions. The odds of MI were not significantly increased among patients with 1–2 MetS conditions.


Johans CE, Bajic P, Kirshenbaum E, et al. Metabolic syndrome increases risk of postoperative myocardial infarction following percutaneous nephrolithotomy. J Endourol. 2018; published online ahead of print.