Triglyceride-glucose index is associated with recurrent revascularization in patients with type 2 diabetes mellitus after percutaneous coronary intervention

Abstract

Background: The TyG index, a reliable surrogate marker of insulin resistance, is independently associated with the severity of coronary artery lesions and the prognosis of coronary heart disease. The investigation aimed to explore the relationship between the TyG index and recurrent revascularization in individuals with type 2 diabetes mellitus (T2DM) resulting from the progression of lesions or in-stent restenosis (ISR). Method: A total of 598 patients who met the inclusion and exclusion criteria were enrolled and divided into two groups based on the cut-off value determined through receiver operating characteristic (ROC) curve analysis. The primary endpoint was recurrent revascularization resulting from the progression of lesions or ISR. Cumulative curves were derived using the Kaplan-Meier method, while multivariate Cox regression analysis was employed to identify predictors of recurrent revascularization. The predictive ability of the TyG index was evaluated using several measures, including the ROC curve, likelihood ratio test, Akaike's information criteria, continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Internal validation was conducted through bootstrapping with 1000 resamples. Results: During a median follow-up period of 19.00 months, a total of 62 (10.37%) patients experienced recurrent revascularization, including 53 cases of lesion progression and 9 cases of in-stent restenosis. After adjusting for potential confounders, the TyG index demonstrated an independent association with the primary endpoint in patients with diabetes (HR 1.9462, 95% CI: 1.2314 - 3.0760, P= 0.0044). The likelihood ratio test and Akaike's information criteria showed that the TyG index significantly improves the prognostic ability. Additionally, adding the TyG index improved the ability of the established risk model in predicting recurrent revascularization, indicated by a C-index of 0.776 (95% CI 0.724 – 0.828, P<0.01), with an NRI of 0.242 (95% CI 0.050–0.450, P=0.01), and an IDI of 0.024 (95% CI 0.003–0.077, P=0.02). These results remained consistent when the models were confirmed using an internal bootstrap validation method. Conclusion: The findings highlight the potential of the TyG index as a valuable predictor of recurrent revascularization. Lesion progression emerged as the primary contributor to recurrent revascularization instead of in-stent restenosis. The incorporation of the TyG index into risk prediction models is likely to be beneficial for accurate risk stratification in order to improve prognosis.