The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.
Department of Cardiology, Boshan District Hospital, Zibo, China.
Cardiovasc Diabetol. 2022 Jul 29;21(1):142. doi: 10.1186/s12933-022-01576-8.
Premature coronary artery disease (PCAD) has become more common in recent years and is often associated with poor outcomes. Triglyceride-glucose (TyG) index is a simple and reliable surrogate for insulin resistance (IR) and is an independent predictor of cardiovascular prognosis. However, the prognostic value of the TyG index in patients with PCAD remains uncertain. Thus, this study aimed to investigate the prognostic value and predictive performance of the TyG index in patients with PCAD.
A total of 526 young subjects (male < 45 years, female < 55 years) with angiographically proven CAD from January 2013 to December 2018 were included consecutively in this study. Their clinical and laboratory parameters were collected, and the TyG index was calculated as [Formula: see text]. The follow-up time after discharge was 40-112 months (median, 68 months; interquartile range, 49‒83 months). The primary endpoint was the occurrence of the major adverse cardiovascular events (MACE), defined as the composite of all-cause death, non-fatal myocardial infarction (MI), coronary artery revascularization, and non-fatal stroke.
The TyG index was significantly associated with traditional cardiovascular risk factors and the Gensini score (GS). Kaplan-Meier survival (MACE-free) curves by tertiles of the TyG index showed statistically significant differences (log-rank test, p = 0.001). In the fully adjusted Cox regression model, the Hazard ratio (95% CI) of MACE was 2.17 (1.15-4.06) in tertile 3 and 1.45 (1.11-1.91) for per SD increase in the TyG index. Time-dependent ROC analyses of the TyG for prediction of MACE showed the area under the curves (AUC) reached 0.631 at 3 years, 0.643 at 6 years, and 0.710 at 9 years. Furthermore, adding TyG index to existing risk prediction model could improve outcome prediction [C-statistic increased from 0.715 to 0.719, p = 0.007; continuous net reclassification improvement (NRI) = 0.101, p = 0.362; integrated discrimination improvement (IDI) = 0.011, p = 0.017].
The TyG index is an independent predictor of MACE in patients with PCAD, suggesting that the TyG index has important clinical implications for risk stratification and early intervention of PCAD.
近年来，过早发生的冠状动脉疾病（PCAD）变得更为常见，且常与不良预后相关。甘油三酯-葡萄糖（TyG）指数是胰岛素抵抗（IR）的简单可靠替代指标，也是心血管预后的独立预测因子。然而，TyG 指数在 PCAD 患者中的预后价值仍不确定。因此，本研究旨在探讨 TyG 指数在 PCAD 患者中的预后价值和预测性能。
连续纳入 2013 年 1 月至 2018 年 12 月期间经血管造影证实的 526 名年轻患者（男性<45 岁，女性<55 岁）。收集他们的临床和实验室参数，并计算 TyG 指数[公式：见文本]。出院后随访时间为 40-112 个月（中位数，68 个月；四分位距，49-83 个月）。主要终点为主要不良心血管事件（MACE）的发生，定义为全因死亡、非致死性心肌梗死（MI）、冠状动脉血运重建和非致死性卒中的复合事件。
TyG 指数与传统心血管危险因素和 Gensini 评分（GS）显著相关。按 TyG 指数三分位数的 Kaplan-Meier 生存（MACE 无事件）曲线显示出统计学显著差异（对数秩检验，p=0.001）。在完全调整的 Cox 回归模型中，MACE 的风险比（95%置信区间）在三分位数 3 中为 2.17（1.15-4.06），在 TyG 指数每增加 1 个标准差时为 1.45（1.11-1.91）。TyG 对 MACE 预测的时间依赖性 ROC 分析显示，曲线下面积（AUC）在 3 年时达到 0.631，在 6 年时达到 0.643，在 9 年时达到 0.710。此外，将 TyG 指数加入到现有的风险预测模型中可以改善预后预测[C 统计量从 0.715 增加到 0.719，p=0.007；连续净重新分类改善（NRI）=0.101，p=0.362；综合判别改善（IDI）=0.011，p=0.017]。
TyG 指数是 PCAD 患者 MACE 的独立预测因子，提示 TyG 指数对 PCAD 的危险分层和早期干预具有重要的临床意义。
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