Triglyceride-Glucose Index as a Surrogate Marker of Insulin Resistance for Predicting Cardiovascular Outcomes in Nondiabetic Patients with Non-ST-Segment Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Abstract

Aim: The triglyceride-glucose index (TyG index) is proposed as a surrogate parameter for insulin resistance (IR) and, when elevated, is related to increased cardiovascular risks. Whether the TyG index is of great value in predicting adverse prognosis for individuals diagnosed with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), who received elective percutaneous coronary intervention (PCI), and without recognized diabetes remains unclear. Methods: Overall, 1,510 subjects diagnosed with NSTE-ACS, who received elective PCI, and without recognized diabetes were enrolled in the current study. All participants received a routine follow-up after discharge. The TyG index was obtained from the following equation: napierian logarithmic (ln) [fasting triglyceride (TG, mg/dL)×fasting blood glucose (FBG, mg/dL)/2]. Adverse cardiovascular events included all-cause death, nonfatal myocardial infarction (MI), nonfatal ischemic stroke, and ischemia-driven revascularization, composite of which was defined as the primary endpoint. Results: Overall, 316 (20.9%) endpoint events were documented during a 48-month follow-up. Despite adjusting for confounding variates, the TyG index remains to be a significant risk predictor for the primary endpoint, with a hazard ratio (HR) [95% confidence interval (CI)] of 2.433 (1.853-3.196) ( P ＜0.001). A significant enhancement on the predictive performance for the primary endpoint emerged when adding the TyG index into a baseline model [area under the receiver-operating characteristic (ROC) curve (AUC), 0.835 for baseline model vs. 0.853 for baseline model＋TyG index, P ＜0.001; net reclassification improvement (NRI), 0.194, P ＜0.001; integrated discrimination improvement (IDI), 0.023, P =0.007]. Conclusions: The TyG index is an independent risk predictor for adverse cardiovascular events in nondiabetic subjects diagnosed with NSTE-ACS and who received elective PCI. Further prospective studies are needed to verify these findings.

Triglyceride-Glucose Index Predicts Adverse Events in Patients with Acute Coronary Syndrome: A Meta-Analysis of Cohort Studies

“…2a). Consistent results were obtained for meta-analysis with TyG index analyzed as continuous variables (4 studies [20,21,23,24], RR for 1-SD increment of TyG index: 1.59, 95 % CI: 1.38-1.83, I 2 = 24 %, p < 0.001; ▶ Fig. 2b).…”

“…Besides, TyG index has also been related with the severity of coronary calcification [15,16]. However, the association between TyG index and the incidence of major adverse cardiovascular events (MACEs) in patients with ACS remains not fully determined [17][18][19][20][21][22][23][24]. Therefore, in this study, we aimed to summarize the potential independent association between TyG index and subsequent incidence of MACEs in ACS patients by performing a meta-analysis of previous published cohort studies.…”

“…Mean ages of the included patients with ACS varied from 59 to 67 years. All of the included studies provided data of TyG index analyzed as a categorized variable, while 4 studies also analyzed as a continuous variable [20,21,23,24]. With a follow-up duration of 1~3 years, 2762 patients had subsequent MACEs.…”

The Impact of the Triglyceride-Glucose Index on Poor Prognosis in NonDiabetic Patients Undergoing Percutaneous Coronary Intervention

“…In the research process, the main endpoint was set as outcomes including all-cause mortality, MI, ischemic stroke, and repeat revascularization due to myocardial ischemia. The results indicated that this index was an independent predictive factor in NSTE-ACS patients without DM ( 34 ). However, no existing studies have concentrated on nondiabetic patients who underwent PCI.…”

The Association Between Triglyceride-Glucose Index, Cardio-Cerebrovascular Diseases, and Death in Korean Adults: A Longitudinal Study Based on the NHIS-HEALS Cohort

“…who reported that an elevated TyG index forecasted the risk of ischemic heart disease in Korean population [24]. Zhao et al reported that the TyG index is an independent marker for cardiovascular events [25]. However, these studies have a smaller population size and did not stratify the study population according to sex.…”