Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China.
Cardiovasc Diabetol. 2021 Sep 18;20(1):190. doi: 10.1186/s12933-021-01383-7.
Insulin resistance (IR), evaluation of which is difficult and complex, is closely associated with cardiovascular disease. Recently, various IR surrogates have been proposed and proved to be highly correlated with IR assessed by the gold standard. It remains indistinct whether different IR surrogates perform equivalently on prognostic prediction and stratification following percutaneous coronary intervention (PCI) in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients with and without type 2 diabetes mellitus (T2DM).
The present study recruited patients who were diagnosed with NSTE-ACS and successfully underwent PCI. IR surrogates evaluated in the current study included triglyceride-glucose (TyG) index, visceral adiposity index, Chinese visceral adiposity index, lipid accumulation product, and triglyceride-to-high density lipoprotein cholesterol ratio, calculations of which were conformed to previous studies. The observational endpoint was defined as the major adverse cardiovascular and cerebrovascular events (MACCE), including cardiac death, non-fatal myocardial infarction, and non-fatal ischemic stroke.
2107 patients (60.02 ± 9.03 years, 28.0% female) were ultimately enrolled in the present study. A total of 187 (8.9%) MACCEs were documented during the 24-month follow-up. Despite regarding the lower median as reference [hazard ratio (HR) 3.805, 95% confidence interval (CI) 2.581-5.608, P < 0.001] or evaluating 1 normalized unit increase (HR 1.847, 95% CI 1.564-2.181, P < 0.001), the TyG index remained the strongest risk predictor for MACCE, independent of confounding factors. The TyG index showed the most powerful diagnostic value for MACCE with the highest area under the receiver operating characteristic curve of 0.715. The addition of the TyG index, compared with other IR surrogates, exhibited the maximum enhancement on risk stratification for MACCE on the basis of a baseline model (Harrell's C-index: 0.708 for baseline model vs. 0.758 for baseline model + TyG index, P < 0.001; continuous net reclassification improvement: 0.255, P < 0.001; integrated discrimination improvement: 0.033, P < 0.001). The results were consistent in subgroup analysis where similar analyses were performed in patients with and without T2DM, respectively.
The TyG index, which is most strongly associated with the risk of MACCE, can be served as the most valuable IR surrogate for risk prediction and stratification in NSTE-ACS patients receiving PCI, with and without T2DM.
胰岛素抵抗（IR）的评估既困难又复杂，与心血管疾病密切相关。最近，已经提出了各种 IR 替代物，并证明它们与通过金标准评估的 IR 高度相关。在接受经皮冠状动脉介入治疗（PCI）的非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）患者中，不同的 IR 替代物在预测和分层预后方面是否表现相当，目前仍不清楚。
本研究纳入了诊断为 NSTE-ACS 并成功接受 PCI 的患者。目前研究中评估的 IR 替代物包括甘油三酯-葡萄糖（TyG）指数、内脏脂肪指数、中国内脏脂肪指数、脂质蓄积产物和甘油三酯与高密度脂蛋白胆固醇比值，这些计算均符合之前的研究。观察终点定义为主要不良心血管和脑血管事件（MACCE），包括心脏死亡、非致死性心肌梗死和非致死性缺血性卒中。
本研究共纳入 2107 例患者（60.02±9.03 岁，28.0%为女性）。在 24 个月的随访期间，共记录到 187 例（8.9%）MACCE。尽管将中位数较低作为参考（危险比[HR]3.805，95%置信区间[CI]2.581-5.608，P<0.001）或评估 1 个标准化单位增加（HR 1.847，95%CI 1.564-2.181，P<0.001），TyG 指数仍然是 MACCE 的最强风险预测因子，不受混杂因素影响。TyG 指数对 MACCE 的诊断价值最高，ROC 曲线下面积最高为 0.715。与其他 IR 替代物相比，TyG 指数在基于基线模型的 MACCE 风险分层方面表现出最大的增强作用（Harrell's C 指数：基线模型为 0.708，基线模型+TyG 指数为 0.758，P<0.001；连续净重新分类改善：0.255，P<0.001；综合鉴别改善：0.033，P<0.001）。在分别对合并和不合并 2 型糖尿病的患者进行亚组分析时，结果一致。
与 MACCE 风险最密切相关的 TyG 指数，可作为接受 PCI 的 NSTE-ACS 患者（合并和不合并 2 型糖尿病）风险预测和分层的最有价值的 IR 替代物。
