Combination of TyG Index and GRACE Risk Score as Long-Term Prognostic Marker in Patients with ACS Complicated with T2DM Undergoing PCI

Abstract

We aimed to investigate the prognostic value of the triglyceride-glucose (TyG) index combined the with Global Registry of Acute Coronary Events (GRACE) score in adult acute coronary syndrome (ACS) patients with type 2 diabetes mellitus (T2DM) who underwent percutaneous coronary intervention (PCI). Methods: The study enrolled total 899 ACS patients with T2DM who underwent PCI. TyG index and the GRACE risk score were calculated and assessed by median. The correlation was analyzed by Spearman's rank correlation coefficient. The cumulative major adverse cardiovascular event (MACE) curve was generated using the Kaplan-Meier method. Multivariate Cox regression was used to identify predictors of MACEs. Additionally, the receiver operating characteristic curve (ROC), net reclassification index (NRI) and Integrated Discrimination Improvement (IDI) were applied to analyze the performance of each single factor index and combined multivariate index in predicting MACE. Results: In the ACS patients with T2DM after PCI, there were significant differences in the TyG index and GRACE risk score between the MACE group and the MACE-free group (P < 0.001). Kaplan-Meier analysis showed that the TyG index combined with the GRACE risk score was positively correlated with the occurrence of MACEs (log rank P < 0.001). Multivariate Cox regression analyses showed that the TyG index, the GRACE risk score, and the TyG index combined with the GRACE risk score were independent predictors of long-term MACEs (adjusted HR: 1.805; 95% CI: 1.479-2.203, P < 0.001; adjusted HR: 1.012; 95% CI: 1.009-1.016, P < 0.001; and adjusted HR: 2.337; 95% CI: 1.805-3.025, P < 0.001, respectively). Correlation analysis indicated that the TyG index was positively correlated with the GRACE risk score (R = 0.140, P < 0.001). The analysis of AUC, NRI and IDI revealed that the combined multivariate index performed better prognostic role than each single factor index in predicting the occurrence of MACE. Conclusion: Both the GRACE risk score and the TyG index could be significant and independent predictors of clinical outcomes in ACS patients with T2DM after PCI. A combination of them could be enhanced predictions of clinical outcomes in these patients.

Triglyceride Glucose Index in the Prediction of Adverse Cardiovascular Events in Patients with Coronary Artery Diseases

“…The twenty observational cohort studies [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] with the total population of1,52,846 (Range: 386-141243)were enrolled between the year 2002 to 2020 with mean age of 59.4 years, published from 2018-2023. A study byZhaiet al 19 reported in-hospital mortality while other nineteen studies had only reported major cardiac adverse eventsat 1 year to 13.2years median time follow-up.…”

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

“…Two of the included studies failed to account for statistical differences in smoking between groups. 22,25 Excluding these two trials revealed a significant correlation between the TyG index and post-PCI MACE risk. Due to the limited purview of the research, smoking-specific correlations were not evaluated in this study; therefore, future research is necessary.…”

“…The incidence of TyG index and post‐PCI MACE is affected by smoking. Two of the included studies failed to account for statistical differences in smoking between groups 22,25 . Excluding these two trials revealed a significant correlation between the TyG index and post‐PCI MACE risk.…”

“…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.…”

“…( P < 0.0001; HR = 2.28; 95% CI 1.58–3.03; I 2 = 78%), based on a meta‐analysis of 4 cohort studies involving 3122 individuals 22,24,25 ( Figure ).…”