三酰甘油-葡萄糖指数作为一种合适的非胰岛素相关胰岛素抵抗标志物，用于预测接受复杂冠状动脉介入治疗的患者的心血管事件：一项大规模队列研究。
Triglyceride-glucose index as a suitable non-insulin-based insulin resistance marker to predict cardiovascular events in patients undergoing complex coronary artery intervention: a large-scale cohort study.
机构信息
State Key Laboratory of Cardiovascular Disease, Beijing, China.
Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
Cardiovasc Diabetol. 2024 Jan 6;23(1):15. doi: 10.1186/s12933-023-02110-0.
BACKGROUND
Insulin resistance (IR), a hallmark of proceeding diabetes and cardiovascular (CV) disease, has been shown to predict prognosis in patients undergoing percutaneous coronary intervention (PCI). The triglyceride-glucose (TyG) index, triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio and metabolic score for insulin resistance (METS-IR) have been shown to be simple and reliable non-insulin-based surrogates for IR. However, limited studies have determined the associations between distinct non-insulin-based IR markers and CV outcomes in patients undergoing complex PCI who are at higher risk of CV events after PCI. Therefore, this study aimed to investigate and compare the prognostic value of these markers in patients undergoing complex PCI.
METHODS
This was a descriptive cohort study. From January 2017 to December 2018, a total of 9514 patients undergoing complex PCI at Fuwai Hospital were consecutively enrolled in this study. The 3 IR indices were estimated from the included patients. The primary study endpoint was CV events, defined as a composite of CV death, nonfatal myocardial infarction and nonfatal stroke.
RESULTS
During a median follow-up of 3.1 years, 324 (3.5%) CV events occurred. Multivariable Cox regression models showed per-unit increase in the TyG index (hazard ratio [HR], 1.42; 95% confidence interval [CI] 1.13-1.77), rather than per-unit elevation in either Ln(TG/HDL-C ratio) (HR, 1.18; 95%CI 0.96-1.45) or METS-IR (HR, 1.00; 95%CI 0.98-1.02), was associated with increased risk of CV events. Meanwhile, adding the TyG index to the original model led to a significant improvement in C-statistics (0.618 vs. 0.627, P < 0.001), NRI (0.12, P = 0.031) and IDI (0.14%, P = 0.003), whereas no significant improvements were observed when adding Ln (TG/HDL-C ratio) or METS-IR (both P > 0.05) to the original model.
CONCLUSIONS
The TyG index, not TG/HDL-C ratio and METS-IR, was positively associated with worse CV outcomes in patients undergoing complex PCI. Our study, for the first time, demonstrated that the TyG index can serve as the suitable non-insulin-based IR marker to help in risk stratification and prognosis in this population.
背景
胰岛素抵抗（IR）是糖尿病和心血管（CV）疾病进展的标志，已被证明可预测接受经皮冠状动脉介入治疗（PCI）的患者的预后。三酰甘油-葡萄糖（TyG）指数、三酰甘油与高密度脂蛋白胆固醇（TG/HDL-C）比值和胰岛素抵抗代谢评分（METS-IR）已被证明是简单可靠的非胰岛素替代物，用于评估 IR。然而，有限的研究已经确定了在接受复杂 PCI 的患者中，这些不同的非胰岛素依赖型 IR 标志物与 CV 结局之间的关联，这些患者在 PCI 后发生 CV 事件的风险更高。因此，本研究旨在探讨和比较这些标志物在接受复杂 PCI 的患者中的预后价值。
方法
这是一项描述性队列研究。2017 年 1 月至 2018 年 12 月，共有 9514 例在阜外医院接受复杂 PCI 的患者连续纳入本研究。从纳入的患者中估算了 3 个 IR 指数。主要研究终点为 CV 事件，定义为 CV 死亡、非致死性心肌梗死和非致死性卒中等复合终点。
结果
在中位随访 3.1 年期间，发生 324 例（3.5%）CV 事件。多变量 Cox 回归模型显示，TyG 指数每增加一个单位（危险比 [HR]，1.42；95%置信区间 [CI] 1.13-1.77），而不是 Ln（TG/HDL-C 比值）每增加一个单位（HR，1.18；95%CI 0.96-1.45）或 METS-IR（HR，1.00；95%CI 0.98-1.02），与 CV 事件风险增加相关。同时，将 TyG 指数添加到原始模型中导致 C 统计量（0.618 对 0.627，P<0.001）、NRI（0.12，P=0.031）和 IDI（0.14%，P=0.003）显著改善，而当将 Ln（TG/HDL-C 比值）或 METS-IR（均 P>0.05）添加到原始模型时，未观察到显著改善。
结论
在接受复杂 PCI 的患者中，TyG 指数与更差的 CV 结局呈正相关，而不是 TG/HDL-C 比值和 METS-IR。本研究首次证明，TyG 指数可以作为合适的非胰岛素依赖型 IR 标志物，有助于对该人群进行风险分层和预后评估。
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