Abstract
BackgroundInsulin resistance (IR), evaluation of which is difficult and complex, is closely associated with cardiovascular disease. Recently, various IR surrogates have been proposed and proved to be highly correlated with IR assessed by the gold standard. It remains indistinct whether different IR surrogates perform equivalently on prognostic prediction and stratification following percutaneous coronary intervention (PCI) in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients with and without type 2 diabetes mellitus (T2DM).MethodsThe present study recruited patients who were diagnosed with NSTE-ACS and successfully underwent PCI. IR surrogates evaluated in the current study included triglyceride-glucose (TyG) index, visceral adiposity index, Chinese visceral adiposity index, lipid accumulation product, and triglyceride-to-high density lipoprotein cholesterol ratio, calculations of which were conformed to previous studies. The observational endpoint was defined as the major adverse cardiovascular and cerebrovascular events (MACCE), including cardiac death, non-fatal myocardial infarction, and non-fatal ischemic stroke.Results2107 patients (60.02 ± 9.03 years, 28.0% female) were ultimately enrolled in the present study. A total of 187 (8.9%) MACCEs were documented during the 24-month follow-up. Despite regarding the lower median as reference [hazard ratio (HR) 3.805, 95% confidence interval (CI) 2.581–5.608, P < 0.001] or evaluating 1 normalized unit increase (HR 1.847, 95% CI 1.564–2.181, P < 0.001), the TyG index remained the strongest risk predictor for MACCE, independent of confounding factors. The TyG index showed the most powerful diagnostic value for MACCE with the highest area under the receiver operating characteristic curve of 0.715. The addition of the TyG index, compared with other IR surrogates, exhibited the maximum enhancement on risk stratification for MACCE on the basis of a baseline model (Harrell’s C-index: 0.708 for baseline model vs. 0.758 for baseline model + TyG index, P < 0.001; continuous net reclassification improvement: 0.255, P < 0.001; integrated discrimination improvement: 0.033, P < 0.001). The results were consistent in subgroup analysis where similar analyses were performed in patients with and without T2DM, respectively.ConclusionThe TyG index, which is most strongly associated with the risk of MACCE, can be served as the most valuable IR surrogate for risk prediction and stratification in NSTE-ACS patients receiving PCI, with and without T2DM.
Highlights
Insulin resistance (IR), evaluation of which is difficult and complex, is closely associated with cardiovas‐ cular disease
The TyG index, which is most strongly associated with the risk of major adverse cardiovascular and cerebrovascular events (MACCE), can be served as the most valuable IR surrogate for risk prediction and stratification in NSTE-ACS patients receiving percutaneous coronary intervention (PCI), with and without type 2 diabetes mellitus (T2DM)
More patients were diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI) and treated with angiotensin-converting enzyme inhibitor (ACEI)/ angiotensin receptor blocker (ARB), oral antidiabetic agents, and insulin in the MACCE group
Summary
Insulin resistance (IR), evaluation of which is difficult and complex, is closely associated with cardiovas‐ cular disease. Various IR surrogates have been proposed and proved to be highly correlated with IR assessed by the gold standard. It remains indistinct whether different IR surrogates perform equivalently on prognostic predic‐ tion and stratification following percutaneous coronary intervention (PCI) in non-ST-segment elevation acute coro‐ nary syndrome (NSTE-ACS) patients with and without type 2 diabetes mellitus (T2DM). The hyperinsulinaemic-euglycaemic (HIEG) clamp, which is the gold standard technique for the evaluation of IR, has been demonstrated to be closely associated with ASCVD by previous studies [7, 8]. The level of IR assessed by these surrogates has been shown in numerous studies to be significantly associated with the risk of prediabetes/diabetes, atherosclerosis, ASCVD, and adverse prognosis [17,18,19,20,21,22,23,24,25,26]
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