Abstract
BackgroundThe triglyceride glucose (TyG) index, a simple surrogate estimate of insulin resistance, has been demonstrated to predict cardiovascular (CV) disease morbidity and mortality in the general population and many patient cohorts. However, to our knowledge, the prognostic usefulness of the TyG index after percutaneous coronary intervention (PCI) in patients with type 2 diabetes mellitus (T2DM) and acute coronary syndrome (ACS) has not been determined. This study aimed to evaluate the association of the TyG index with adverse CV outcomes in patients with T2DM and ACS who underwent PCI.MethodsThe TyG index was calculated using the formula ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. The primary endpoint was the composite of all-cause mortality, non-fatal stroke, non-fatal myocardial infarction, or unplanned repeat revascularization. The association between the TyG index and adverse CV outcomes was assessed by Cox proportional hazards regression analysis.ResultsIn total, 776 patients with T2DM and ACS who underwent PCI (mean age, 61 ± 10 years; men, 72.2%) were included in the final analysis. Over a median follow-up of 30 months, 188 patients (24.2%) had at least 1 primary endpoint event. The follow-up incidence of the primary endpoint rose with increasing TyG index tertiles. The multivariate Cox proportional hazards regression analysis adjusted for multiple confounders revealed a hazard ratio for the primary endpoint of 2.17 (95% CI 1.45–3.24; P for trend = 0.001) when the highest and lowest TyG index tertiles were compared.ConclusionsThe TyG index was significantly and positively associated with adverse CV outcomes, suggesting that the TyG index may be a valuable predictor of adverse CV outcomes after PCI in patients with T2DM and ACS.
Highlights
The triglyceride glucose (TyG) index, a simple surrogate estimate of insulin resistance, has been demonstrated to predict cardiovascular (CV) disease morbidity and mortality in the general population and many patient cohorts
When the analysis was stratified by clinical presentation, we found that a higher TyG index was significantly associated with an increased risk of the primary endpoint in patients with unstable angina, and the similar result occurred in patients with acute myocardial infarction (MI)
When the analysis was stratified by age, we found that a higher TyG index was significantly associated with an increased risk of the primary endpoint in patients aged 70 years and younger; the similar result did not occur in patients aged over 70 years
Summary
The triglyceride glucose (TyG) index, a simple surrogate estimate of insulin resistance, has been demonstrated to predict cardiovascular (CV) disease morbidity and mortality in the general population and many patient cohorts. To our knowledge, the prognostic usefulness of the TyG index after percutaneous coronary intervention (PCI) in patients with type 2 diabetes mellitus (T2DM) and acute coronary syndrome (ACS) has not been determined. This study aimed to evaluate the association of the TyG index with adverse CV outcomes in patients with T2DM and ACS who underwent PCI. Some patients with ACS remain at high risk for recurrent cardiovascular (CV) events despite the use of current guidelinerecommended therapies, including prompt coronary. Ma et al Cardiovasc Diabetol (2020) 19:31 revascularization, dual anti-platelet therapy, and intensive lipid-lowering therapy. This risk is high among patients with type 2 diabetes mellitus (T2DM), who account for approximately one-third of ACS cases [2, 3]. Early identification of diabetic patients with ACS undergoing PCI who have a high residual risk is crucial for better clinical management to reduce future CV events
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