Comparison of various insulin resistance surrogates on prognostic prediction and stratification following percutaneous coronary intervention in patients with and without type 2 diabetes mellitus

Abstract

Background Insulin resistance (IR), evaluation of which is difficult and complex, is closely associated with cardiovascular disease. Recently, various IR surrogates have been proposed and proved to be highly correlated with IR assessed by the gold standard. It remains indistinct whether different IR surrogates perform equivalently on prognostic prediction and stratification following percutaneous coronary intervention (PCI) in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients with and without type 2 diabetes mellitus (T2DM). Methods The present study recruited patients who were diagnosed with NSTE-ACS and successfully underwent PCI. IR surrogates evaluated in the current study included triglyceride-glucose (TyG) index, visceral adiposity index, Chinese visceral adiposity index, lipid accumulation product, and triglyceride-to-high density lipoprotein cholesterol ratio, calculations of which were conformed to previous studies. The observational endpoint was defined as the major adverse cardiovascular and cerebrovascular events (MACCE), including cardiac death, non-fatal myocardial infarction, and non-fatal ischemic stroke. Results 2107 patients (60.02 ± 9.03 years, 28.0% female) were ultimately enrolled in the present study. A total of 187 (8.9%) MACCEs were documented during the 24-month follow-up. Despite regarding the lower median as reference [hazard ratio (HR) 3.805, 95% confidence interval (CI) 2.581–5.608, P < 0.001] or evaluating 1 normalized unit increase (HR 1.847, 95% CI 1.564–2.181, P < 0.001), the TyG index remained the strongest risk predictor for MACCE, independent of confounding factors. The TyG index showed the most powerful diagnostic value for MACCE with the highest area under the receiver operating characteristic curve of 0.715. The addition of the TyG index, compared with other IR surrogates, exhibited the maximum enhancement on risk stratification for MACCE on the basis of a baseline model (Harrell’s C-index: 0.708 for baseline model vs. 0.758 for baseline model + TyG index, P < 0.001; continuous net reclassification improvement: 0.255, P < 0.001; integrated discrimination improvement: 0.033, P < 0.001). The results were consistent in subgroup analysis where similar analyses were performed in patients with and without T2DM, respectively. Conclusion The TyG index, which is most strongly associated with the risk of MACCE, can be served as the most valuable IR surrogate for risk prediction and stratification in NSTE-ACS patients receiving PCI, with and without T2DM.

Prognostic Significance of Triglyceride-Glucose Index for Adverse Cardiovascular Events in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis

“…All the included studies were published within the last 5 years and were situated in China. Of the 12 studies, one ( 27 ) enrolled stable CAD, 10 ( 28 – 35 , 37 , 38 ) enrolled acute coronary syndrome (ACS), and one ( 36 ) enrolled both chronic coronary syndrome and ACS. The average age of 12 studies ranged from 55.7 to 66.3 years.…”

“…The follow-up duration ranged from 12 to 48 months. Four studies ( 30 , 31 , 33 , 34 ) included diabetic patients; three studies ( 32 , 35 , 36 ) included non-diabetic patients; five ( 27 – 29 , 37 , 38 ) studies included both diabetic patients and non-diabetic patients. Methodological quality assessment using NOS indicated the good quality of all enrolled works of literature ( Supplementary File 2 ).…”

“…In the meta-analysis of the TyG index evaluated as a categorical variable, 10 studies ( 28 – 35 , 37 , 38 ) reported the association between the TyG index and the risk of MACEs in patients with CAD. As illustrated in Figure 2 , the pooled HR of MACEs comparing the highest TyG index group to the lowest TyG index group was 2.14 (95% CI: 1.69–2.71, P < 0.001).…”

“…Figure 1 shows the literature selection process. About 12 studies (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) with a total of 28,795 patients with CAD were finally included in the qualitative and quantitative analysis. All the included studies were published within the last 5 years and were situated in China.…”

Association between triglyceride glucose index and carotid artery plaque in different glucose metabolic states in patients with coronary heart disease: a RCSCD-TCM study in China

“…Type 2 diabetes mellitus (T2DM) accounts for 95% of all the diseases diagnosed with DM. Which is one of the risk factors for coronary artery disease (CAD) and the progression and rupture of atherosclerotic plaques [ 3 ]. CAD is also a common comorbidity and major cause of death in DM patients.…”