糖尿病和甘油三酯葡萄糖指数对接受冠状动脉计算机断层扫描血管造影的慢性冠状动脉综合征患者死亡率和心血管结局的影响。

Impact of diabetes mellitus and triglyceride glucose index on mortality and cardiovascular outcomes in patients with chronic coronary syndrome undergoing coronary computed tomography angiography.

作者信息

Otsuka Kenichiro, Yamaura Hiroki, Shimada Kenei, Sugiyama Takatoshi, Hojo Kana, Ishikawa Hirotoshi, Kono Yasushi, Kasayuki Noriaki, Fukuda Daiju

机构信息

Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.

Department of Cardiovascular Medicine, Fujiikai Kashibaseiki Hospital, Kashiba, Japan.

出版信息

Int J Cardiol Cardiovasc Risk Prev. 2024 Feb 24;20:200250. doi: 10.1016/j.ijcrp.2024.200250. eCollection 2024 Mar.

DOI:10.1016/j.ijcrp.2024.200250

PMID:38476976

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10928368/

Abstract

BACKGROUND

There is limited knowledge regarding whether an elevated triglyceride glucose (TyG) index can serve as a prognostic marker for mortality and cardiovascular outcomes, independent of diabetes mellitus (DM) and plaque burden, in patients with chronic coronary syndrome (CCS).

METHODS

Patients with CCS (n = 684) were categorized into subgroups based on the presence of DM, and patients without DM were further divided into two groups based on presence or absence of an elevation of TyG index >8.8. Coronary plaque burden was evaluated using coronary computed tomography angiography. Major cardiovascular adverse event (MACE) was defined as a composite event of nonfatal myocardial infarction, unstable angina or unplanned coronary revascularization, stroke, non-cardiovascular mortality and cardiovascular mortality.

RESULTS

Patients without DM exhibited significantly greater plaque and epicardial adipose tissue volumes than those with DM. Multivariable Cox proportional hazards models demonstrated that DM and an elevated TyG index >8.8 were independently associated with the risk of MACE after adjusting for age, sex, and plaque volume. Patients with DM (hazard ratio, 3.74; 95% confidence interval, 1.97-7.08; p < 0.001) and patients without DM with an elevated TyG index (hazard ratio, 1.99; 95% confidence interval, 1.01-3.91; p = 0.045) had an increased risk of MACE.

CONCLUSION

This study indicates that DM and an elevated TyG index are predictors of MACE, independent of plaque volume, in patients with CCS.

摘要

背景

关于在慢性冠状动脉综合征（CCS）患者中，甘油三酯葡萄糖（TyG）指数升高是否可作为独立于糖尿病（DM）和斑块负荷的死亡率及心血管结局的预后标志物，目前所知有限。

方法

将CCS患者（n = 684）根据DM的存在情况分为亚组，无DM的患者再根据TyG指数升高（>8.8）与否进一步分为两组。使用冠状动脉计算机断层扫描血管造影评估冠状动脉斑块负荷。主要心血管不良事件（MACE）定义为非致命性心肌梗死、不稳定型心绞痛或计划外冠状动脉血运重建、中风、非心血管死亡率和心血管死亡率的复合事件。

结果

无DM的患者比有DM的患者表现出明显更大的斑块和心外膜脂肪组织体积。多变量Cox比例风险模型表明，在调整年龄、性别和斑块体积后，DM和TyG指数升高>8.8与MACE风险独立相关。有DM的患者（风险比，3.74；95%置信区间，1.97 - 7.08；p < 0.001）和TyG指数升高的无DM患者（风险比，1.99；95%置信区间，1.01 - 3.91；p = 0.045）发生MACE的风险增加。