Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, No.95, Yongan Road, Xicheng District, Beijing, 100050, People's Republic of China.
Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, China.
Cardiovasc Diabetol. 2023 Jun 26;22(1):149. doi: 10.1186/s12933-023-01890-9.
Elevated triglyceride-glucose (TyG) index and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are independently associated with increased risk of major adverse cardio-cerebral events (MACCEs) in diabetic patients with the acute coronary syndrome (ACS), but have not been evaluated jointly. We sought to investigate the independent and joint association of the TyG index and NT-proBNP with MACCEs risk.
Data from 5046 patients with diabetes and ACS were recorded in the Cardiovascular Center Beijing Friendship Hospital Database Bank between 2013 and 2021, including measurements of fasting triglycerides, plasma glucose, and NT-proBNP. The TyG index was calculated as Ln (fasting triglycerides [mg/dL] × fasting plasma glucose [mg/dL]/2). Associations of the TyG index and NT-proBNP with MACCEs risk were assessed using flexible parametric survival models.
During 13589.9 person-years of follow-up, 985 incident MACCEs of the 5046 patients (65.6 years of age and 62.0% men) were observed. Elevated TyG index (HR: 1.18; 95% CI 1.05‒1.32 per 1 unit increase) and NT-proBNP categories (HR: 1.95; 95% CI: 1.50‒2.54 for > 729 pg/ml compared to < 129 pg/ml) were independently associated with MACCEs risk in the fully adjusted model. According to the joint categories of the TyG index and NT-proBNP, patients with the TyG index > 9.336 and NT-proBNP > 729 pg/ml were at the highest risk of MACCEs (HR: 2.45; 95% CI 1.64‒3.65) than the ones with TyG index < 8.746 and NT-proBNP < 129 pg/ml. The test for interaction was not significant (P = 0.49). Incorporating these two biomarkers into the established clinical model, the Global Registry of Acute Coronary Events (GRACE) risk score, resulted in a significant improvement in risk stratification.
The TyG index and NT-proBNP were independently and jointly associated with the risk of MACCEs in patients with diabetes and ACS, suggesting that patients with both markers elevated should be aware of the higher risk in the future.
甘油三酯-葡萄糖（TyG）指数和 N 末端 pro-B 型利钠肽（NT-proBNP）升高与糖尿病合并急性冠状动脉综合征（ACS）患者发生主要不良心脑血管事件（MACCEs）的风险增加独立相关，但尚未对其联合进行评估。我们旨在研究 TyG 指数和 NT-proBNP 与 MACCEs 风险的独立和联合关联。
2013 年至 2021 年期间，北京友谊医院心血管中心数据库银行记录了 5046 例糖尿病合并 ACS 患者的数据，包括空腹甘油三酯、血浆葡萄糖和 NT-proBNP 测量值。TyG 指数的计算方法为 Ln（空腹甘油三酯[mg/dL]×空腹血浆葡萄糖[mg/dL]/2）。使用灵活参数生存模型评估 TyG 指数和 NT-proBNP 与 MACCEs 风险的关联。
在 13589.9 人年的随访期间，观察到 5046 例患者中有 985 例发生 MACCEs（65.6 岁，62.0%为男性）。在完全调整模型中，升高的 TyG 指数（HR：1.18；95%CI：每增加 1 单位为 1.05‒1.32）和 NT-proBNP 类别（HR：1.95；95%CI：729pg/ml 相比<129pg/ml）与 MACCEs 风险独立相关。根据 TyG 指数和 NT-proBNP 的联合类别，TyG 指数>9.336 和 NT-proBNP>729pg/ml 的患者发生 MACCEs 的风险最高（HR：2.45；95%CI：1.64‒3.65），高于 TyG 指数<8.746 和 NT-proBNP<129pg/ml 的患者。交互检验无统计学意义（P=0.49）。将这两个生物标志物纳入已建立的临床模型，即全球急性冠状动脉事件注册（GRACE）风险评分，可显著改善风险分层。
TyG 指数和 NT-proBNP 与糖尿病合并 ACS 患者发生 MACCEs 的风险独立且联合相关，提示同时存在这两种标志物升高的患者应注意未来的更高风险。
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