Triglyceride-glucose index in the prediction of adverse cardiovascular events in patients with premature coronary artery disease: a retrospective cohort study

Abstract

Background Premature coronary artery disease (PCAD) has become more common in recent years and is often associated with poor outcomes. Triglyceride-glucose (TyG) index is a simple and reliable surrogate for insulin resistance (IR) and is an independent predictor of cardiovascular prognosis. However, the prognostic value of the TyG index in patients with PCAD remains uncertain. Thus, this study aimed to investigate the prognostic value and predictive performance of the TyG index in patients with PCAD. Methods A total of 526 young subjects (male < 45 years, female < 55 years) with angiographically proven CAD from January 2013 to December 2018 were included consecutively in this study. Their clinical and laboratory parameters were collected, and the TyG index was calculated as $$\mathrm{Ln}[\mathrm{fasting triglyceride }(\mathrm{TG}) (\mathrm{mg}/\mathrm{dL})\times \mathrm{fasting plasma glucose }(\mathrm{FPG}) (\mathrm{mg}/\mathrm{dL})/2]$$ Ln [ fasting triglyceride ( TG ) ( mg / dL ) × fasting plasma glucose ( FPG ) ( mg / dL ) / 2 ] . The follow-up time after discharge was 40–112 months (median, 68 months; interquartile range, 49‒83 months). The primary endpoint was the occurrence of the major adverse cardiovascular events (MACE), defined as the composite of all-cause death, non-fatal myocardial infarction (MI), coronary artery revascularization, and non-fatal stroke. Results The TyG index was significantly associated with traditional cardiovascular risk factors and the Gensini score (GS). Kaplan–Meier survival (MACE-free) curves by tertiles of the TyG index showed statistically significant differences (log-rank test, p = 0.001). In the fully adjusted Cox regression model, the Hazard ratio (95% CI) of MACE was 2.17 (1.15–4.06) in tertile 3 and 1.45 (1.11–1.91) for per SD increase in the TyG index. Time-dependent ROC analyses of the TyG for prediction of MACE showed the area under the curves (AUC) reached 0.631 at 3 years, 0.643 at 6 years, and 0.710 at 9 years. Furthermore, adding TyG index to existing risk prediction model could improve outcome prediction [C-statistic increased from 0.715 to 0.719, p = 0.007; continuous net reclassification improvement (NRI) = 0.101, p = 0.362; integrated discrimination improvement (IDI) = 0.011, p = 0.017]. Conclusion The TyG index is an independent predictor of MACE in patients with PCAD, suggesting that the TyG index has important clinical implications for risk stratification and early intervention of PCAD.

The Correlation between the Triglyceride-Glucose Index and Coagulation Markers in Patients with Recent Acute Myocardial Infarction

“…The metabolic syndrome is a known predictor of cardiovascular events in patients with established CAD [28][29][30]. Recent research has identified the TyG index as a reliable marker of metabolic syndrome and a strong predictor of CAD, premature CAD, and adverse events in CAD patients [10][11][12][13]28]. In our study, values of the TyG index were comparable to those from previous studies in patients with CAD, wherein TyG index values were also associated with an increased event risk [11].…”

“…One such biomarker is the triglyceride-glucose (TyG) index, which has been proposed as a marker of metabolic syndrome and has been associated with carotid atherosclerosis, coronary artery calcification, and higher risk of cardiovascular disease [7][8][9]. Moreover, recent studies have identified the TyG index as an independent predictor of coronary calcification progression, of clinical outcomes in patients with stable CAD and premature CAD, and of cardiovascular outcomes in acute coronary syndromes [7,[10][11][12][13].…”

Association of triglyceride–glucose index and traditional risk factors with cardiovascular disease among non-diabetic population: a 10-year prospective cohort study

“…There were studies evidenced the improvement for predicting adverse cardiovascular events by adding the TyG index in patients after PCI and elderly ACS patients and patients with PCAD [ 24 , 38 , 39 ]. And we found that the addition of the TyG index to the baseline risk model also significantly improved its predictive value in non-diabetic general population without a history of CVD in Eastern China.…”

Effect of dapagliflozin on the prognosis of patients with acute myocardial infarction undergoing percutaneous coronary intervention

“…As AIP and the TyG index are associated with MACE in patients with AMI undergoing PCI [ 14 , 15 ], the effects of DAPA administration on AIP and the TyG index 12 months after discharge were evaluated. As shown in Fig.…”