Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Nutr Metab Cardiovasc Dis. 2021 Oct 28;31(11):3184-3192. doi: 10.1016/j.numecd.2021.07.027. Epub 2021 Aug 4.
Triglyceride-glucose (TyG) index has been reported as a novel surrogate marker of insulin resistance and a risk factor in patients with coronary artery disease. We aimed to investigate the prognostic value of TyG index in a distinct entity with myocardial infarction with nonobstructive coronary arteries (MINOCA).
A total of 1179 MINOCA patients were recruited and divided according to tertile levels of TyG index. The primary endpoint was a composite of major adverse cardiovascular events (MACE), including all-cause death, reinfarction, stroke, revascularization and hospitalization for unstable angina or heart failure. Kaplan-Meier, Cox regression and receiver-operating characteristic analyses were performed. Patients with higher tertiles of TyG index had a significantly higher incidence of MACE (9.6%, 14.9%, 18.0%; p = 0.003) over the median follow-up of 41.7 months. After multivariate adjustment, elevated TyG index was significantly associated with an increased risk of MACE (HR 1.33, 95% CI: 1.04-1.69, p = 0.020). The adjusted risk of MACE also increased with rising tertiles of TyG index (tertile 1 as reference; tertile 2: HR 1.64, 95% CI: 1.06-2.53, p = 0.025; tertile 3: HR 1.85, 95% CI: 1.17-2.93, p = 0.008). The TyG index remained a robust risk factor in overall and subgroups of MINOCA patients (all p < 0.05). Moreover, the TyG index yielded a moderate predictive value of MACE (area under the curve 0.66, 95% CI:0.61-0.71, p < 0.001).
Elevated TyG index was independently associated with a poor prognosis after MINOCA. Routine assessment of TyG index may improve risk stratification and facilitate decision making in MINOCA patients.
甘油三酯-葡萄糖（TyG）指数已被报道为胰岛素抵抗的新型替代标志物，也是冠状动脉疾病患者的危险因素。我们旨在探讨 TyG 指数在非阻塞性冠状动脉心肌梗死（MINOCA）这一特殊实体中的预后价值。
共纳入 1179 例 MINOCA 患者，根据 TyG 指数的三分位水平进行分组。主要终点是主要不良心血管事件（MACE）的复合终点，包括全因死亡、再梗死、卒中和血运重建以及不稳定型心绞痛或心力衰竭住院。进行 Kaplan-Meier 分析、Cox 回归分析和受试者工作特征（ROC）分析。TyG 指数较高三分位组的 MACE 发生率明显更高（9.6%、14.9%、18.0%；p=0.003），中位随访时间为 41.7 个月。多变量调整后，升高的 TyG 指数与 MACE 风险增加显著相关（HR 1.33，95%CI：1.04-1.69，p=0.020）。随着 TyG 指数三分位的升高，MACE 的调整风险也随之增加（以三分位 1 为参照；三分位 2：HR 1.64，95%CI：1.06-2.53，p=0.025；三分位 3：HR 1.85，95%CI：1.17-2.93，p=0.008）。TyG 指数在 MINOCA 患者的整体和亚组中仍然是一个强有力的危险因素（均 p<0.05）。此外，TyG 指数对 MACE 具有中等的预测价值（曲线下面积 0.66，95%CI：0.61-0.71，p<0.001）。
升高的 TyG 指数与 MINOCA 后不良预后独立相关。常规评估 TyG 指数可能有助于改善 MINOCA 患者的风险分层和决策制定。
