National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.
Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
Diabetes Metab Res Rev. 2023 Nov;39(8):e3710. doi: 10.1002/dmrr.3710. Epub 2023 Aug 3.
We aimed to investigate the independent and combined association of the triglyceride-glucose (TyG) index and EuroSCORE II with major adverse cardiovascular event (MACE) after coronary artery bypass grafting (CABG), and examine whether the addition of the TyG index improves the predictive performance of the EuroSCORE II.
This study included 1013 patients who underwent CABG. The primary endpoint was MACE, which was defined as the composite of all-cause death, repeat coronary artery revascularisation, non-fatal myocardial infarction and non-fatal stroke. The patients were grouped by the TyG index and EuroSCORE II tertiles and the combination of these risk indicators.
During the follow-up, 211 individuals developed MACE. Elevated levels of the TyG index and EuroSCORE II were associated with an increased risk of MACE. The hazard ratio [95% confidence interval (CI)] was 3.66 (2.34-5.73) in patients with the highest tertile of the TyG index and EuroSCORE II. Compared with the EuroSCORE II alone, combining the TyG index with EuroSCORE II achieved a better predictive performance [C-statistic increased 0.032, p < 0.001; continuous net reclassification improvement (NRI) (95% CI): 0.364 (0.215-0.514), p < 0.001; integrated discrimination improvement (IDI) (95% CI): 0.015 (0.007-0.023), p < 0.001, Akaike's information criteria (AIC) and Bayesian information criterion (BIC) decreased, and the likelihood ratio test, p < 0.001].
The TyG index and EuroSCORE II are independently associated with poor prognosis. Furthermore, the TyG index is an important adjunct to the EuroSCORE II for improving risk stratification and guiding early intervention among post-CABG patients.
本研究旨在探讨三酰甘油-葡萄糖（TyG）指数和欧洲心脏手术风险评估系统（EuroSCORE II）与冠状动脉旁路移植术后（CABG）主要不良心血管事件（MACE）的独立和联合相关性，并检验 TyG 指数的加入是否能提高 EuroSCORE II 的预测性能。
本研究纳入了 1013 名接受 CABG 的患者。主要终点为 MACE，定义为全因死亡、再次冠状动脉血运重建、非致死性心肌梗死和非致死性卒中的复合终点。根据 TyG 指数和 EuroSCORE II 三分位数以及这些风险指标的组合对患者进行分组。
在随访期间，有 211 名患者发生了 MACE。TyG 指数和 EuroSCORE II 升高与 MACE 风险增加相关。TyG 指数和 EuroSCORE II 最高三分位数的患者发生 MACE 的风险比（95%置信区间）为 3.66（2.34-5.73）。与单独使用 EuroSCORE II 相比，将 TyG 指数与 EuroSCORE II 相结合可获得更好的预测性能[C 统计量增加 0.032，p<0.001；连续净重新分类改善（NRI）（95%CI）：0.364（0.215-0.514），p<0.001；综合判别改善（IDI）（95%CI）：0.015（0.007-0.023），p<0.001，Akaike 信息准则（AIC）和贝叶斯信息准则（BIC）降低，似然比检验，p<0.001]。
TyG 指数和 EuroSCORE II 与不良预后独立相关。此外，TyG 指数是 EuroSCORE II 的重要补充，可以改善 CABG 术后患者的风险分层和指导早期干预。
