Department of Cardiology, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Beijing, 100029, China.
China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Eur J Med Res. 2023 Oct 17;28(1):437. doi: 10.1186/s40001-023-01410-1.
The triglyceride-glucose (TyG) index is validated as a reliable biomarker of insulin resistance and an independent predictor of cardiovascular prognosis. However, the prognostic value of the TyG index in patients on dialysis with coronary artery disease (CAD) remained unexplored. This study aimed to determine the association between the TyG index and CAD severity and mortality in these patients.
A total of 1061 dialysis patients with CAD were enrolled in this multi-center cohort study from January 2015 to June 2021. The extent and severity of CAD were evaluated using the multivessel disease and Gensini score (GS). Patients were followed up for all-cause death and cardiovascular death.
The multivariable logistic regression model indicated that the TyG index was significantly associated with multivessel disease (odds ratio [OR] 1.51, 95% confidence interval [CI] 1.18-1.94, P = 0.001), and high GS (OR 1.33, 95% CI 1.10-1.61, P = 0.003). After adjusting for baseline risk factors, the hazards of all-cause death and cardiovascular death were 1.23 (95% CI 1.06-1.43, P = 0.007), and 1.33 (95% CI 1.11-1.59, P = 0.002), independent of CAD severity. Restricted cubic spline analysis identified a dose-response association between the TyG index and both CAD severity and mortality (all P for nonlinearity > 0.05). When modeling the TyG index as a categorical variable, these independent associations remained. Subgroup analyses did not substantially modify the results. Furthermore, incorporating the TyG index into the existing risk prediction model improved the predictive accuracy for all-cause death and cardiovascular death, as evaluated by C-statistic, continuous net reclassification improvement, and integrated discrimination improvement.
In patients on dialysis with CAD, the TyG index was significantly associated with more severe CAD as well as mortality. These results highlight the clinical importance of the TyG index for assessing CAD severity and risk stratification in patients on dialysis with CAD.
三酰甘油-葡萄糖（TyG）指数已被验证为胰岛素抵抗的可靠生物标志物，也是心血管预后的独立预测因子。然而，TyG 指数在患有冠状动脉疾病（CAD）的透析患者中的预后价值仍未得到探索。本研究旨在确定 TyG 指数与这些患者 CAD 严重程度和死亡率之间的关系。
本多中心队列研究纳入了 2015 年 1 月至 2021 年 6 月期间的 1061 例患有 CAD 的透析患者。使用多血管疾病和 Gensini 评分（GS）评估 CAD 的程度和严重程度。对所有原因死亡和心血管死亡进行随访。
多变量逻辑回归模型表明，TyG 指数与多血管疾病（优势比 [OR] 1.51，95%置信区间 [CI] 1.18-1.94，P = 0.001）和高 GS（OR 1.33，95% CI 1.10-1.61，P = 0.003）显著相关。在校正基线风险因素后，全因死亡和心血管死亡的风险分别为 1.23（95% CI 1.06-1.43，P = 0.007）和 1.33（95% CI 1.11-1.59，P = 0.002），与 CAD 严重程度无关。受限立方样条分析确定了 TyG 指数与 CAD 严重程度和死亡率之间存在剂量反应关系（所有非线性 P 值均大于 0.05）。当将 TyG 指数建模为分类变量时，这些独立关联仍然存在。亚组分析并未实质性改变结果。此外，将 TyG 指数纳入现有的风险预测模型可提高对全因死亡和心血管死亡的预测准确性，评估指标为 C 统计量、连续净重新分类改善和综合鉴别改善。
在患有 CAD 的透析患者中，TyG 指数与更严重的 CAD 以及死亡率显著相关。这些结果强调了 TyG 指数在评估患有 CAD 的透析患者的 CAD 严重程度和风险分层方面的临床重要性。
