Guo Dachuan, Zhang Chong, Zhang Mingyan, Wu Zhenguo, Liu Xiaoyu, Zhang Yerui, Liu Li, Sun Meili, Yang Jianmin
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 Internal Medicine, Jiyang District Traditional Chinese Medicine Hospital, Jinan, China.
Aging (Albany NY). 2024 Apr 1;16(7):6364-6383. doi: 10.18632/aging.205710.
The Metabolic Score for Insulin Resistance (METS-IR) index serves as a simple surrogate marker for insulin resistance (IR) and is associated with the presence and severity of coronary artery disease (CAD). However, the prognostic significance of METS-IR in patients with premature CAD remains unclear. This study aims to investigate the prognostic value of METS-IR in premature CAD.
This retrospective study included 582 patients diagnosed with premature CAD between December 2012 and July 2019. The median follow-up duration was 63 months (interquartile range, 44-81 months). The primary endpoint was Major Adverse Cardiovascular Events (MACE), defined as a composite of all-cause death, non-fatal myocardial infarction (MI), repeat coronary artery revascularization, and non-fatal stroke.
Patients with MACE had significantly higher METS-IR levels than those without MACE (44.88±8.11 vs. 41.68±6.87, <0.001). Kaplan-Meier survival curves based on METS-IR tertiles demonstrated a statistically significant difference (log-rank test, <0.001). In the fully adjusted model, the Hazard Ratio (95% CI) for MACE was 1.41 (1.16-1.72) per SD increase in METS-IR, and the P for trend based on METS-IR tertiles was 0.001 for MACE. Time-dependent Receiver Operator Characteristic (ROC) analysis of METS-IR yielded an Area Under the Curve (AUC) of 0.74 at 2 years, 0.69 at 4 years, and 0.63 at 6 years.
METS-IR serves as a reliable prognostic predictor of MACE in patients with premature CAD. Therefore, METS-IR may be considered a novel, cost-effective, and dependable indicator for risk stratification and early intervention in premature CAD.
胰岛素抵抗代谢评分（METS-IR）指数是胰岛素抵抗（IR）的一种简单替代标志物，与冠状动脉疾病（CAD）的存在及严重程度相关。然而，METS-IR在早发CAD患者中的预后意义仍不明确。本研究旨在探讨METS-IR在早发CAD中的预后价值。
这项回顾性研究纳入了2012年12月至2019年7月期间诊断为早发CAD的582例患者。中位随访时间为63个月（四分位间距，44 - 81个月）。主要终点是主要不良心血管事件（MACE），定义为全因死亡、非致死性心肌梗死（MI）、再次冠状动脉血运重建和非致死性卒中的复合事件。
发生MACE的患者METS-IR水平显著高于未发生MACE的患者（44.88±8.11 vs. 41.68±6.87，<0.001）。基于METS-IR三分位数的Kaplan-Meier生存曲线显示出统计学显著差异（对数秩检验，<0.001）。在完全调整模型中，METS-IR每增加1个标准差，MACE的风险比（95%CI）为1.41（1.16 - 1.72），基于METS-IR三分位数的MACE趋势P值为0.001。METS-IR的时间依赖性受试者工作特征（ROC）分析显示，2年时曲线下面积（AUC）为0.74，4年时为0.69，6年时为0.63。
METS-IR是早发CAD患者MACE的可靠预后预测指标。因此，METS-IR可被视为早发CAD风险分层和早期干预的一种新型、经济有效且可靠的指标。
