Wang Shipan, Li Yilin, Han Hao, Han Tianxu, Yang Zhiran, Li Youjin, Yang Haiping, Li Hongli, Liu Gang, Zhu Minjia, Huang Jian, Zhao Qingwu, Liu Jihong, Li Haibin, Zhang Shuaitong, Xue Yuan, Zhang Hongjia, Li Haiyang
Department of Cardiac Surgery, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, Beijing, China.
Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China.
Open Heart. 2025 Sep 23;12(2):e003673. doi: 10.1136/openhrt-2025-003673.
Postoperative cerebral infarction following coronary artery bypass grafting (CABG) for multivessel coronary artery disease (CAD) is a major complication and is associated with insulin resistance (IR). This study used the Triglyceride-Glucose (TyG) Index, a robust indicator of IR, to assess its association with cerebral infarction and other adverse events in patients with off-pump CABG (OPCABG).
This retrospective observational study included 3654 CAD cases from eight centres across China. The primary outcome was postoperative cerebral infarction. The predictive role of the TyG Index was evaluated using multivariate logistic regression and restricted cubic spline regression. Receiver operating characteristics analysis was conducted to assess its impact on model performance.
A total of 89 patients experienced postoperative cerebral infarction. After adjusting for confounding factors, the TyG Index, whether treated as a categorical variable (OR=2.23, 95% CI 1.24 to 4.02) or a continuous variable (OR=1.80, 95% CI 1.29 to 2.51), was found to be a significant independent risk factor for postoperative cerebral infarction (both p<0.001). The restricted cubic splines regression model revealed a linear dose-response association between the TyG Index and the risk of postoperative cerebral infarction (p for non-linearity=0.861). Subgroup analysis did not indicate any interactions among subgroups (p for interaction >0.05). Incorporating the TyG Index yielded a modest but statistically significant improvement in discrimination for postoperative cerebral infarction (area under the receiver operating characteristics curve 0.724 vs 0.708; p<0.001).
IR reflected by an elevated TyG Index predicts the risk of postoperative cerebral infarction in patients undergoing OPCABG.
Chinese Clinical Trial Registry: Chictr2400085741.
多支冠状动脉疾病（CAD）患者行冠状动脉旁路移植术（CABG）后发生的术后脑梗死是一种主要并发症，且与胰岛素抵抗（IR）相关。本研究使用甘油三酯-葡萄糖（TyG）指数（一种可靠的IR指标）来评估其与非体外循环冠状动脉旁路移植术（OPCABG）患者脑梗死及其他不良事件的关联。
这项回顾性观察性研究纳入了来自中国八个中心的3654例CAD病例。主要结局为术后脑梗死。使用多因素逻辑回归和限制性立方样条回归评估TyG指数的预测作用。进行受试者工作特征分析以评估其对模型性能的影响。
共有89例患者发生术后脑梗死。在调整混杂因素后，发现TyG指数无论是作为分类变量（OR=2.23，95%CI 1.24至4.02）还是连续变量（OR=1.80，95%CI 1.29至2.51），均是术后脑梗死的显著独立危险因素（均p<0.001）。限制性立方样条回归模型显示TyG指数与术后脑梗死风险之间存在线性剂量反应关联（非线性p=0.861）。亚组分析未显示亚组间存在任何交互作用（交互作用p>0.05）。纳入TyG指数对术后脑梗死的鉴别能力有适度但具有统计学意义的改善（受试者工作特征曲线下面积0.724对0.708；p<0.001）。
TyG指数升高所反映的IR可预测OPCABG患者术后脑梗死的风险。
中国临床试验注册中心：Chictr2400085741。
