Abstract
Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is the leading cause of morbidity and mortality from cardiovascular disease worldwide. Several recent studies have shown the relationship between the triglyceride-glucose (TyG) index and vascular disease; however, the role of the TyG index in NSTE-ACS has not been extensively assessed. Thus, we aimed to investigate the association of the TyG index with cardiovascular risk factors and outcomes in NSTE-ACS. Overall, 438 patients with NSTE-ACS were enrolled to examine the association of the TyG index with the SYNTAX score and major adverse cardiovascular events (MACEs). The TyG index was calculated as ln (fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2). The severity of coronary lesions was quantified by the SYNTAX score. MACEs included cardiac death, nonfatal myocardial infarction, target vessel revascularization, congestive heart failure, and nonfatal stroke. All the patients underwent a 12-month follow-up for MACEs after admission. Multivariate regression analysis identified metabolic risk factors as independent parameters correlated with the TyG index. The prevalence of glucose metabolism disorder, metabolic syndrome, and MACEs increased with increasing TyG index. The TyG index showed a strong diagnostic performance for cardiovascular risk factors and was independently associated with the SYNTAX score (OR 6.055, 95% CI 2.915–12.579, P < 0.001). The risk of MACEs (12.8% and 22.8% for the low TyG index and high TyG index groups, respectively; adjusted HR = 1.791, 95% CI 1.045–3.068, P = 0.034) significantly increased in the high TyG index group as compared with the low TyG index group. The multivariate Cox regression analysis further revealed that the TyG index was an independent predictor of MACEs (HR 1.878, 95% CI 1.130–3.121, P = 0.015). In conclusion, the TyG index might be an independent predictor of coronary artery disease severity and cardiovascular outcomes in NSTE-ACS.
Highlights
Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is the leading cause of morbidity and mortality from cardiovascular disease worldwide [1,2,3]
The patients with a high TyG index had a higher incidence of diabetes (P < 0 001), Glucose metabolism disorder (GMD) (P < 0 001), and metabolic syndrome (MetS) (P < 0 001), had more severe coronary artery lesion (P < 0 001), and had a higher Global Registry of Acute Coronary Events (GRACE) score (P < 0 001)
The main findings are as follows: (1) the TyG index is correlated with multiple cardiovascular risk factors and (2) the TyG index is an independent predictor of coronary artery disease severity and major adverse cardiovascular events (MACEs)
Summary
Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is the leading cause of morbidity and mortality from cardiovascular disease worldwide [1,2,3]. It is crucial to identify patients at high risk of developing future adverse cardiovascular events that may contribute to optimal management. Insulin resistance (IR) is a hallmark of metabolic syndrome (MetS) and is considered to be a pivotal risk factor for cardiometabolic diseases [4, 5]. A high IR level is associated with increasing risk of developing cardiovascular disease (CVD) and is significantly associated with high risk of cardiovascular outcomes [6, 7]. Direct measurement methods of IR (the hyperinsulinemic euglycemic glucose clamp and the insulin suppression test) are invasive, costly, and complicated procedures [8]. Simple and accessible markers of IR are required for epidemiological study and clinical practice
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