三酰甘油-葡萄糖指数与经皮冠状动脉介入治疗的既往冠状动脉旁路移植术的急性冠状动脉综合征患者预后不良相关。

Triglyceride-glucose index is associated with poor prognosis in acute coronary syndrome patients with prior coronary artery bypass grafting undergoing percutaneous coronary intervention.

机构信息

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.

出版信息

Cardiovasc Diabetol. 2023 Oct 27;22(1):286. doi: 10.1186/s12933-023-02029-6.

BACKGROUND

The triglyceride-glucose (TyG) index, which is a reliable substitute indicator for insulin resistance, has been considered an independent risk factor for long-term outcomes in patients with cardiovascular disease. However, it remains unknown whether the TyG index is associated with poor prognosis in acute coronary syndrome (ACS) patients with prior coronary artery bypass grafting (CABG) undergoing percutaneous coronary intervention (PCI).

METHODS

A total of 1158 ACS patients with prior CABG undergoing PCI were retrospectively studied. The TyG index was calculated by ln[fasting triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2]. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), a composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and unplanned repeat revascularization.

RESULTS

During a median of 42-month follow-up, 350 patients (30.2%) experienced at least one endpoint event. Based on the optimal cut-off value of the TyG index, patients were divided into the high TyG index group and the low TyG index group. Patients in the high TyG index group had higher risks of MACCE (35.3% vs. 25.3%, p < 0.001), major adverse cardiovascular events (MACE) (31.1% vs. 23.4%, p = 0.003), nonfatal stroke (4.2% vs. 1.9%, p = 0.022) and unplanned repeat revascularization (19.4% vs. 11.3%, p < 0.001) than those in the low TyG index group. Cox regression analysis demonstrated that there was an independent association between the TyG index and MACCE regardless of whether the TyG index was a continuous or categorical variable (HR 1.42, 95% CI 1.09-1.86, p = 0.009; HR 1.53, 95% CI 1.16-2.01, p = 0.003, respectively). Restricted cubic spline curve exhibited that the relationship between the TyG index and MACCE was linear (p for non-linear = 0.595, p for overall = 0.005). By incorporating the TyG index groups into baseline risk model, the accuracy of predicting MACCE was improved [AUC: baseline risk model, 0.618 vs. baseline risk model + TyG index groups, 0.636, p for comparison = 0.042].

CONCLUSIONS

The TyG index is independently associated with MACCE, suggesting that the TyG index may serve as a valid indicator for predicting poor prognosis in ACS patients with prior CABG undergoing PCI.

背景

三酰甘油-葡萄糖（TyG）指数是胰岛素抵抗的可靠替代指标，已被认为是心血管疾病患者长期预后的独立危险因素。然而，目前尚不清楚 TyG 指数与既往接受冠状动脉旁路移植术（CABG）行经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者的不良预后是否相关。

方法

回顾性分析了 1158 例既往接受 CABG 并行 PCI 的 ACS 患者。TyG 指数通过 ln[空腹三酰甘油（mg/dL）×空腹血糖（mg/dL）/2]计算。主要终点为主要不良心脑血管事件（MACCE），包括全因死亡、非致死性心肌梗死、非致死性卒中和计划外再次血运重建。

结果

在中位随访 42 个月期间，350 例患者（30.2%）发生至少 1 次终点事件。根据 TyG 指数的最佳截断值，患者分为高 TyG 指数组和低 TyG 指数组。高 TyG 指数组患者发生 MACCE（35.3% vs. 25.3%，p<0.001）、主要不良心血管事件（MACE）（31.1% vs. 23.4%，p=0.003）、非致死性卒中和计划外再次血运重建（4.2% vs. 1.9%，p=0.022 和 19.4% vs. 11.3%，p<0.001）的风险均高于低 TyG 指数组。Cox 回归分析表明，TyG 指数与 MACCE 之间存在独立关联，无论 TyG 指数是连续变量还是分类变量（HR 1.42，95%CI 1.09-1.86，p=0.009；HR 1.53，95%CI 1.16-2.01，p=0.003）。限制性立方样条曲线显示 TyG 指数与 MACCE 之间呈线性关系（p 非线性=0.595，p 整体=0.005）。将 TyG 指数组纳入基线风险模型后，预测 MACCE 的准确性得到提高[AUC：基线风险模型，0.618 vs. 基线风险模型+TyG 指数组，0.636，p 比较=0.042]。