Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
Department of Anesthesia, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
Sci Rep. 2024 Aug 5;14(1):18083. doi: 10.1038/s41598-024-69158-0.
The effect of systemic inflammation, represented by high-sensitivity C-reactive protein (hsCRP), on triglyceride glucose (TyG) index-associated cardiovascular risk in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) has not yet been determined. This study was a retrospective analysis of a single-center prospective registry and finally included 1701 patients (age, 60 ± 10 years; male, 76.7%). The primary endpoint was defined as major adverse cardiovascular events (MACE), including cardiovascular mortality, non-fatal stroke, and non-fatal myocardial infarction. In the multivariate COX regression model that included the GRACE risk score, higher TyG index was significantly associated with a greater incidence of MACE in patients with hsCRP levels less than 2 mg/L but not 2 mg/L or more (P for interaction = 0.039). Each unit increase in the TyG index was independently associated with a 52% increased risk of MACE only in patients with hsCRP levels less than 2 mg/L (P = 0.021). After adjustment for other confounding factors, including the GRACE risk score, compared with those in the group of TyG index < 8.62 and hsCRP < 2 mg/L, patients in the group of TyG index ≥ 8.62 and hsCRP ≥ 2 mg/L had a 3.9 times higher hazard ratio for developing MACE. The addition of both TyG index and hsCRP had an incremental effect on the predictive ability of the GRACE risk score-based prognostic model for MACE (C-statistic: increased from 0.631 to 0.661; cNRI: 0.146, P = 0.012; IDI: 0.009, P < 0.001). In conclusion, there was a significant interaction between the TyG index and hsCRP for the risk of MACE, and the TyG index was reliably and independently associated with MACE only when hsCRP levels were less than 2 mg/L. Furthermore, high TyG index and high hsCRP levels synergistically increased the risk of MACE, suggesting that the prognostic value of TyG index combined with hsCRP might be promising in patients with ACS undergoing PCI.
高敏 C 反应蛋白（hsCRP）代表的全身炎症对行经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者的甘油三酯-葡萄糖（TyG）指数相关心血管风险的影响尚未确定。本研究对单中心前瞻性登记处进行了回顾性分析，最终纳入 1701 例患者（年龄 60±10 岁；男性 76.7%）。主要终点定义为主要不良心血管事件（MACE），包括心血管死亡、非致死性卒中和非致死性心肌梗死。在包括 GRACE 风险评分的多变量 COX 回归模型中，hsCRP<2mg/L 时 TyG 指数越高，MACE 发生率越高，但 hsCRP≥2mg/L 时则不然（交互作用 P=0.039）。hsCRP<2mg/L 时 TyG 指数每增加一个单位，MACE 风险增加 52%，但 hsCRP≥2mg/L 时则不然（P=0.021）。在校正其他混杂因素，包括 GRACE 风险评分后，与 TyG 指数<8.62 且 hsCRP<2mg/L 的患者相比，TyG 指数≥8.62 且 hsCRP≥2mg/L 的患者发生 MACE 的危险比为 3.9 倍。TyG 指数和 hsCRP 的联合应用对基于 GRACE 风险评分的预后模型预测 MACE 的能力具有增量效应（C 统计量：从 0.631 增加到 0.661；cNRI：0.146，P=0.012；IDI：0.009，P<0.001）。总之，TyG 指数和 hsCRP 对 MACE 风险有显著的交互作用，hsCRP<2mg/L 时，TyG 指数与 MACE 独立相关且可靠。此外，高 TyG 指数和高 hsCRP 水平协同增加 MACE 风险，提示 TyG 指数联合 hsCRP 在接受 PCI 的 ACS 患者中的预后价值可能很有前景。
