Addition of TyG index to the GRACE score improves prediction of adverse cardiovascular outcomes in patients with non-ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention: A retrospective study

Abstract

BackgroundThe Global Registry of Acute Coronary Events (GRACE) score is a widely recognized tool for predicting adverse cardiovascular events in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). The triglyceride-glucose index (TyG index) is a new biomarker of insulin resistance and has a close association with the occurrence of adverse cardiovascular events. We investigated whether the addition of the TyG index to the GRACE score could improve prognosis prediction in patients with NSTE-ACS undergoing percutaneous coronary intervention (PCI).MethodsIn total, 515 patients with NSTE-ACS undergoing PCI were included in this retrospective study. Kaplan-Meier analysis was performed to describe the cumulative incidence of the primary endpoint based on the median TyG index. The relationship between the TyG index and GRACE score was analyzed using Spearman's rank correlation. Univariate and multivariate Cox proportional hazards analyses were used to identify independent risk factors. Based on the receiver operating characteristic curve, net reclassification improvement (NRI), integrated differentiation improvement (IDI), and decision curve analysis, the TyG index was evaluated for its predictive value when added to the GRACE score. ROC curve analyses, NRI, and IDI were used to compare the gain effect of the TyG index and the levels of HbA1C, FBG, TG, and LDL-C on the GRACE score for predicting adverse cardiovascular events.ResultsThe TyG index was an independent predictor of 2-year adverse cardiovascular events in patients with NSTE-ACS undergoing PCI. The addition of the TyG index to the GRACE score demonstrated an improved ability to predict 2-year adverse cardiovascular events compared with the GRACE score alone (AUCs: GRACE score 0.798 vs. GRACE score+TyG index 0.849, P = 0.043; NRI = 0.718, P < 0.001; IDI = 0.086, P < 0.001). The decision curve analysis suggested that the clinical net benefit of the new model (GRACE score+TyG index) was superior to that of the GRACE score alone, with a probability range of 0.04 to 0.32. When including the TyG index, HbA1C, FBG, TG, and LDL-C in the GRACE score system, we found that the TyG index had a greater incremental impact on risk prediction and stratification compared to the other parameters.ConclusionCombining the TyG index and GRACE score could improve the prediction of 2-year adverse cardiovascular events. This new risk model could identify patients with NSTE-ACS at higher risk of adverse events following PCI so that they can be monitored more carefully.

Association of the triglyceride–glucose index with coronary artery disease complexity in patients with acute coronary syndrome

“…Chronic hyperglycemia and dyslipidemia induced by insulin resistance contribute to the development of cardiovascular disease [5]. A higher level of TyG index has been shown to be associated with an increased risk of cardiovascular diseases in the general population [8,[20][21][22], and is an independent predictor of poor prognosis in different cohorts undergoing PCI [23][24][25][26][27][28][29]. One of our previous studies demonstrated that the TyG index could provide additional predictive ability on the top of residual SYNTAX score in predicting intermediate-term major adverse cardiovascular events after PCI in patients with diabetes mellitus [11].…”

Triglyceride-glucose index is associated with recurrent revascularization in patients with type 2 diabetes mellitus after percutaneous coronary intervention

“…Furthermore, recent research has demonstrated that the triglyceride glucose (TyG) index can be utilized to optimize early risk strati cation in patients with coronary artery disease following PCI. The combination of the TyG index and the GRACE score provide a signi cant improvement in prediction of adverse cardiovascular outcomes in patients with non-ST-segment elevation acute coronary syndrome (NSTEMI) [35] or acute coronary syndrome (ACS) [36] undergoing PCI in terms of the C-statistic value, NRI and IDI. The present study additionally revealed that incorporating the TyG index into the established risk model improved model discrimination and risk reclassi cation capabilities, as indicated by a C-index of 0.776 (95% CI 0.724-0.828, P < 0.01), NRI of 0.242 (95% CI 0.050-0.450, P = 0.01), and IDI of 0.024 (95% CI 0.003-0.077, P = 0.02).…”

Triglyceride‐glucose index's link to cardiovascular outcomes post‐percutaneous coronary intervention in China: a meta‐analysis

“…Fifteen of them were eliminated for the ensuing causes: article types with no study data (n = 3), inappropriate study design (n = 2), studies without appropriate outcome measures (n = 2), and overlapping or duplicate studies with those already included (n = 8). In the end, a total of nine cohort studies 11,12,15,[22][23][24][25][26][27] were included, and no randomized controlled trials were included. Table S3 presents the justifications for leaving out the research.…”

“…10 According to studies, higher triglyceride-glucose (TyG) index is associated with an increased risk of MACE following PCI, which comprises all-cause mortality, revascularization, non-fatal myocardial infarction (MI), and ischaemic stroke. 11,12 According to Guo et al, elevated TyG index increases the risk of revascularization and in-stent restenosis following PCI. 13 Regarding arrhythmias, individuals with ST-elevation myocardial infarction who undergo PCI have an elevated risk of developing new-onset atrial fibrillation due to their high TyG index.…”

“…Major adverse cardiovascular events (MACE) nevertheless occur in more than one‐fourth of those who receive PCI afterward 10 . According to studies, higher triglyceride‐glucose (TyG) index is associated with an increased risk of MACE following PCI, which comprises all‐cause mortality, revascularization, non‐fatal myocardial infarction (MI), and ischaemic stroke 11,12 . According to Guo et al, elevated TyG index increases the risk of revascularization and in‐stent restenosis following PCI 13 .…”