Abstract
BackgroundThe triglyceride-glucose (TyG) index is an alternative marker of insulin resistance (IR) and is closely associated with the prevalence and prognosis of atherosclerotic cardiovascular disease (ASCVD). However, the association between the TyG index and in-stent restenosis (ISR) after drug-eluting stent (DES) implantation in patients with acute coronary syndrome (ACS) remains unknown.MethodsThe present study retrospectively recruited patients who were admitted for ACS and underwent coronary angiography at 6 to 24 months after successful DES-based percutaneous coronary intervention (PCI). In addition, we calculated the TyG index with the following formula: Ln(fasting triglyceride [mg/dL] × fasting blood glucose [mg/dL]/2) and divided patients into 3 groups according to the tertile of the TyG index. Most importantly, multivariate logistic regression analysis models were also constructed to assess the association between the TyG index and DES-ISR in patients with ACS.ResultsA total of 1574 patients with ACS (58.4 ± 9.4 years, 77.4% male) were included in this study. At the median follow-up time of 12 (9–14) months, the prevalence of DES-ISR increased stepwise with the increasing tertile of the TyG index (11.6% vs 17.3% vs 19.4%, p = 0.002), and the TyG index was also higher in the ISR group than in the non-ISR group (9.00 ± 0.58 vs 8.84 ± 0.61, p < 0.001). In addition, the positive association between the TyG index and the prevalence of DES-ISR was also determined in the fully adjusted model (TyG, per 1-unit increase: OR 1.424, 95% CI 1.116 to 1.818, p = 0.005; tertile of TyG, the OR (95% CI) values for tertile 2 and tertile 3 were 1.454 (1.013 to 2.087) and 1.634 (1.125 to 2.374), respectively, with tertile 1 as a reference). The association was also reflected in most subgroups. Moreover, adding the TyG index to the predictive model for DES-ISR in patients with ACS could contribute to an increase in C-statistics (0.675 vs 0.659, p = 0.010), categorical net reclassification improvement (0.090, p < 0.001), and integrated discrimination improvement (0.004, p = 0.040).ConclusionAn elevated TyG index was independently and positively associated with DES-ISR in patients with ACS who underwent PCI. However, the incremental predictive value of the TyG index for DES-ISR was slight. To further confirm our findings, future studies are needed.
Highlights
The triglyceride-glucose (TyG) index is an alternative marker of insulin resistance (IR) and is closely associated with the prevalence and prognosis of atherosclerotic cardiovascular disease (ASCVD)
The main exclusion criteria were as follows: (1) age less than 18 years; (2) history of coronary artery bypass grafting (CABG); (3) culprit lesion treated with bare metal stent (BMS)/only underwent balloon angioplasty without drug-eluting stents (DESs) implantation; (4) suspected familial hypertriglyceridaemia; (5) severe hepatic and renal dysfunction (estimated glomerular filtration rate); and (6) acute/chronic inflammatory disease, malignancy, and body mass index (BMI) ≥ 45 kg/ m2
IR is a pathological condition characterized by defects in the uptake and utilization of glucose, which could lead to chronic hyperglycaemia and unique dyslipidaemia characterized by increased circulating TG and low concentrations of high-density lipoprotein-C (HDL-C) [7]
Summary
The triglyceride-glucose (TyG) index is an alternative marker of insulin resistance (IR) and is closely associated with the prevalence and prognosis of atherosclerotic cardiovascular disease (ASCVD). The association between the TyG index and in-stent restenosis (ISR) after drug-eluting stent (DES) implantation in patients with acute coronary syndrome (ACS) remains unknown. Despite considerable improvement in the anti-restenotic performance of drug-eluting stents (DESs), technological evolution of percutaneous coronary intervention (PCI), medical therapy and other secondary prevention strategies in recent years, in-stent restenosis (ISR) remains a major challenge after PCI, and its occurrence ranges from 3 to 20% [1,2,3]. Insulin resistance (IR), a well-established hallmark of metabolic disorders and systemic inflammation [6], is a substantial risk factor for atherosclerotic cardiovascular disease (ASCVD) and contributes to a worse prognosis [7,8,9]. There has been growing interest in determining a reliable, simple, and accessible index to assess IR quantitively
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