Abstract
BackgroundTriglyceride glucose (TyG) index is considered a reliable alternative marker of insulin resistance and an independent predictor of cardiovascular (CV) outcomes. However, the prognostic value of TyG index in patients with type 2 diabetes mellitus (T2DM) and acute myocardial infarction (AMI) remains unclear.MethodsA total of 1932 consecutive patients with T2DM and AMI were enrolled in this study. Patients were divided into tertiles according to their TyG index levels. The incidence of major adverse cardiac and cerebral events (MACCEs) was recorded. The TyG index was calculated as the ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2].ResultsCompeting risk regression revealed that the TyG index was positively associated with CV death [2.71(1.92 to 3.83), p < 0.001], non-fatal MI [2.02(1.32 to 3.11), p = 0.001], cardiac rehospitalization [2.42(1.81 to 3.24), p < 0.001], revascularization [2.41(1.63 to 3.55), p < 0.001] and composite MACCEs [2.32(1.92 to 2.80), p < 0.001]. The area under ROC curve of the TyG index for predicting the occurrence of MACCEs was 0.604 [(0.578 to 0.630), p < 0.001], with the cut-off value of 9.30. The addition of TyG index to a baseline risk model had an incremental effect on the predictive value for MACCEs [net reclassification improvement (NRI): 0.190 (0.094 to 0.337); integrated discrimination improvement (IDI): 0.027 (0.013 to 0.041); C-index: 0.685 (0.663 to 0.707), all p < 0.001].ConclusionsThe TyG index was significantly associated with MACCEs, suggesting that the TyG index may be a valid marker for risk stratification and prognosis in patients with T2DM and AMI.Trial registration Retrospectively registered.
Highlights
Acute myocardial infarction (AMI) has been recognized as the leading cause of morbidity and mortality of cardiovascular diseases(CVDs) worldwide [1]
The predictor associated with major adverse cardiac and cerebral events (MACCEs) occurrence were Triglyceride glucose (TyG) index, age, Body mass index (BMI), duration of diabetes, chronic kidney disease (CKD), previous stroke, past percutaneous coronary intervention (PCI), antiplatelet agent used before admission, white blood cell(WBC), hypersensitive C-reactive protein (hs-CRP), hemoglobin, fasting plasma glucose (FPG), random blood glucose (RBG) at admission, albumin, creatinine, estimated glomerular filtration rate (eGFR), TGs, left ventricular ejection fraction (LVEF), left main coronary artery (LM)/three-disease, proximal left anterior descending (LAD), in-hospital treatment[PCI/coronary artery bypass graft (CABG), antiplatelet agent, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB), beta-blocker and statins] and hypoglycemic agents(insulin)
CKD and creatinine were significantly correlated with eGFR (p < 0.001), and hs-CRP was significantly correlated with White blood cell (WBC) (p < 0.001)
Summary
Acute myocardial infarction (AMI) has been recognized as the leading cause of morbidity and mortality of cardiovascular diseases(CVDs) worldwide [1]. What’s more, some AMI patients remain at high risk for recurrent cardiovascular events (CVEs) despite the use of current guideline-recommended treatment. This risk is high among patients with type 2 diabetes mellitus (T2DM), accounting for approximately 37% of AMI cases in China, and is classified as extreme-risk group for recurrent CVEs [3]. Early identification of the residual risk factors of AMI patients with T 2DM is crucial for better clinical management to reduce future CVEs. Triglyceride glucose (TyG) index is considered a reliable alternative marker of insulin resistance and an independent predictor of cardiovascular (CV) outcomes. The prognostic value of TyG index in patients with type 2 diabetes mellitus (T2DM) and acute myocardial infarction (AMI) remains unclear. The TyG index was calculated as the ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/ dL)/2]
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