Triglyceride glucose index for the detection of the severity of coronary artery disease in different glucose metabolic states in patients with coronary heart disease: a RCSCD-TCM study in China

Abstract

Background Triglyceride glucose (TyG) index is a new marker associated with atherosclerosis. This study aimed to assess the association between TyG index and the severity of coronary artery disease (CAD) in patients with coronary heart disease (CHD) and further explore the association between TyG index and CAD severity in different glucose metabolic states. Methods This multi-centre retrospective study included 731 patients with CHD between January 1, 2014 and September 30, 2020 in China. All patients were stratified into groups based on the tertiles of TyG index (T1: 5.48 ≤ TyG index ≤ 7.17; T2: 7.18 ≤ TyG index ≤ 7.76; T3: 7.77 ≤ TyG index ≤ 10.82). The number of diseased vessels [single-vessel and multi-vessel CAD (≥ 50% stenosis in ≥ 2 large vessels)] represented the severity of CAD, which was measured using coronary angiography (CAG). Glucose metabolic states were defined by the American Diabetes Association as normal glucose regulation (NGR), prediabetes mellitus (Pre-DM), and diabetes mellitus (DM). Results The baseline analysis results showed significant differences in the clinical and biological characteristics of CHD patients according to TyG index tertiles (P < 0.05 to < 0.001). Logistic regression analysis showed that the TyG index was significantly related to the risk of multi-vessel CAD (odds ratio [OR]: 1.715; 95% confidence interval [CI] 1.339–2.197; P < 0.001). The OR for multi-vessel CAD in TyG index T3 compared to that of T1 was 2.280 (95% CI 1.530–3.398; P < 0.001). Receiver operating characteristic (ROC) curve was generated to evaluate the accuracy of the TyG index in detecting the CAD severity, and the area under the curve (AUC) of the ROC plots was 0.601 (95% CI 0.559–0.643). The association between TyG index and multi-vessel CAD was significant in patients with DM, achieving the highest OR among the different glucose metabolic states (OR: 1.717; 95% CI 1.161–2.539; P < 0.05). Conclusion TyG index was associated with CAD severity in patients with CHD, and an increased TyG index could identify patients with a high risk of multi-vessel CAD. There was an association between TyG index and CAD severity for the condition of DM.

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

“…We found that patients with NSTE-ACS and a high TyG index were more likely to have the multivessel disease. Similar to our research, a recent study found that a high TyG was significantly associated with the risk of multivessel coronary artery disease regardless of confounders, such as age, sex, SBP, DBP, history of smoking and alcohol consumption, and drug therapy ( 42 ). This may be another reason the TyG index can predict primary endpoints independent of the GRACE score in some patients.…”

Non-insulin-based insulin resistance indexes in predicting severity for coronary artery disease

“…Results from a large-scale retrospective analysis conducted in South Korea revealed that the group with the highest TyG index had a higher risk of stroke and myocardial infarction [ 31 ]. On the other hand, Su et al [ 13 ] demonstrated that TyG index was associated with CAD severity, while Wang et al [ 2 ] showed that TyG index, as an indicator for evaluating IR, may be a valuable predictor of CAD severity. Our results were consistent with findings from the above-mentioned studies.…”

“…Patients in which only one major coronary artery was involved were considered to have single-vessel CAD, whereas patients with involvement of two or more major coronary arteries were considered to have multivessel CAD. Those without vascular lesions, but with left main coronary artery stenosis ≥ 50% were considered as two lesions [ 13 ].…”

“…Consequently, researchers have adopted triglyceride and glucose (TyG) index [ 8 ], triglyceride glucose-body mass (TyG-BMI) index [ 9 ], triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio [ 10 , 11 ], and metabolic score for insulin resistance (METS-IR) [ 12 ] as simple and reliable substitutes for IR. Previous studies have shown that TyG index, TG/HDL-C ratio and METS-IR are related to the severity of coronary lesions in CAD patient [ 2 , 13 , 14 ], with limited evidence. Further, TyG-BMI index was associated with increased risk of cardiovascular disease (CVD) and stroke [ 15 – 17 ], to date, however, nothing is known regarding the relationship between TyG-BMI index and CAD severity.…”

Triglyceride-glucose index is associated with quantitative flow ratio in patients with acute ST-elevation myocardial infarction after percutaneous coronary intervention

“…At the same time, a meta-analysis summarizing multiple cohort studies found that after adjusting for the effects of age, gender, and DM, the TyG index was still independently associated with the risk of cardiovascular disease ( 29 ). In a RCSCD-TCM study, Su et al conducted a retrospective analysis of 731 patients with CAD and found that the TyG index was associated with the severity of CAD, and an elevated TyG index could increase the risk of coronary multivessel disease ( 30 ). Alessandra et al analyzed baseline data from patients in secondary cardiac care and found that the TyG index was associated with metabolic risk factors for the heart, and that a high level of the TyG index was more likely to develop symptomatic CAD ( 31 ).…”