Abstract 13237: The Combined Effect of Triglyceride-Glucose Index and High Sensitivity C-reactive Protein on Cardiovascular Outcomes in Patients With Chronic Coronary Syndrome: A Multicenter Cohort Study

Abstract

Background: Triglyceride-glucose (TyG) index is a proven non-invasive alternative indicator of insulin resistance. There is an interconnection between insulin resistance and inflammation, and high sensitivity C-reactive protein (hsCRP) is one of the most commonly used biomarkers of systemic inflammation. We aimed to investigate the combined association of TyG and hsCRP with adverse outcomes in patients with chronic coronary syndrome (CCS). Methods: A total of 9421 patients with CCS were finally included in this study. The primary endpoint was defined as a composite of the major adverse cardiovascular events (MACE) covering all-cause death, non-fatal myocardial infarction, and revascularization. Kaplan-Meier analysis and Cox regression models were used to evaluate the relationship between TyG, hsCRP, and cardiovascular events. Results: During the 2-year follow-up period, 660 (7.0%) cases of MACE were recorded. Participants were divided equally into 3 groups according to TyG levels. Compared to the TyG T1 group, the risk of MACE was significantly higher in the TyG T3 group (adjusted HR 1.283, 95% CI 1.037-1.587, P=0.022). In addition, there was a significantly higher risk of MACE in the TyG T3 group with a higher level of hsCRP (> 3 mg/l) (adjusted HR 1.735,95% CI 1.126-2.674, P=0.012). However, the association between TyG and MACE events was attenuated with hsCRP ≤ 3 mg/l (adjusted HR 1.077,95% CI 0.834-1.391, P=0.568). When patients were divided into 6 groups according to hsCRP and TyG, the Cox regression analysis showed that patients in the TyG T3&hsCRP>3 mg/l group had a significantly higher risk of MACE than those in the TyG T1&hsCRP≤3 mg/l group (adjusted HR: 1.577, 95%CI: 1.180-2.108, P=0.002). The Cox regression analysis of secondary endpoints showed that all-cause mortality and myocardial infarction appeared to be the main contributors to the increased risk of MACE. Conclusion: Elevated TyG index serves as a strong predictor of poor prognosis in patients with CCS. Additionally, participants with concurrently elevated hsCRP and TyG had worse clinical outcomes. The concurrent assessment of TyG and hsCRP may be valuable in identifying high-risk groups among CCS patients.