Results of multivariate analysis demonstrated that metabolic syndrome was not an independent predictor for case fatality when adjusted for age, female sex, creatinine clearance, STEMI, anterior wall MI, smoking, admission pulse, systolic and diastolic blood pressures, Killip class greater than I on admission, and previous MI (P = .41). In contrast, metabolic syndrome was a strong and independent predictor of severe heart failure, even after adjustment for potential confounders (ie, age, female sex, anterior wall MI, STEMI, admission pulse, systolic and diastolic blood pressure, anterior wall MI, history of smoking, and creatinine clearance [OR, 2.13; 95% CI, 1.28-3.57; P = .003]). Analysis of the association between individual components of metabolic syndrome and the risk of development of severe heart failure showed that hyperglycemia and low HDL cholesterol level had the strongest association with severe heart failure (Table 4). Among the 5 criteria for metabolic syndrome, only hyperglycemia was an independent determinant for the prediction of cardiogenic shock, even when adjusted for age, female sex, previous MI, anterior wall MI, creatinine clearance, and the other components of metabolic syndrome. Hyperglycemia, as part of the metabolic syndrome criteria, was a strong and independent predictor of severe heart failure (Table 5).