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Cardiovascular diabetology
12 06, 2023;22 (1): 333.

An elevated triglyceride-glucose index predicts adverse outcomes and interacts with the treatment strategy in patients with three-vessel disease.

Yu Zhang, Ce Zhang, Lin Jiang, Lianjun Xu, Jian Tian, Xueyan Zhao, Dong Wang, Yin Zhang, Kai Sun, Channa Zhang, Bo Xu, Wei Zhao, Rutai Hui, Runlin Gao, Jizheng Wang, Xinxing Feng, Jinqing Yuan, Lei Song
Author Information
  1. Yu Zhang: State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, Beijing, 100037, People's Republic of China.
  2. Ce Zhang: State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, Beijing, 100037, People's Republic of China.
  3. Lin Jiang: Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, Beijing, 100037, People's Republic of China.
  4. Lianjun Xu: Cardiomyopathy Ward, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, Beijing, 100037, People's Republic of China.
  5. Jian Tian: Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, Beijing, 100037, People's Republic of China.
  6. Xueyan Zhao: Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, Beijing, 100037, People's Republic of China.
  7. Dong Wang: Cardiomyopathy Ward, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, Beijing, 100037, People's Republic of China.
  8. Yin Zhang: Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, Beijing, 100037, People's Republic of China.
  9. Kai Sun: Information Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, Beijing, 100037, People's Republic of China.
  10. Channa Zhang: State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, Beijing, 100037, People's Republic of China.
  11. Bo Xu: Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, Beijing, 100037, People's Republic of China.
  12. Wei Zhao: Information Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, Beijing, 100037, People's Republic of China.
  13. Rutai Hui: State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, Beijing, 100037, People's Republic of China.
  14. Runlin Gao: Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, Beijing, 100037, People's Republic of China.
  15. Jizheng Wang: State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, Beijing, 100037, People's Republic of China.
  16. Xinxing Feng: Department of Endocrinology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, Beijing, 100037, People's Republic of China. xinxing_feng@hotmail.com.
  17. Jinqing Yuan: Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, Beijing, 100037, People's Republic of China. dr_jinqingyuan@sina.com.
  18. Lei Song: State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, Beijing, 100037, People's Republic of China. songlqd@126.com.
PMID: 38057801 DOI: 10.1186/s12933-023-02063-4

Abstract

BACKGROUND: Insulin resistance is a pivotal risk factor for cardiovascular diseases, and the triglyceride-glucose (TyG) index is a well-established surrogate of insulin resistance. This study aimed to investigate the prognostic value of the TyG index and its ability in therapy guidance in patients with three-vessel disease (TVD).
METHODS: A total of 8862 patients with TVD with available baseline TyG index data were included in the study. The endpoint was major adverse cardiac events (MACE). All patients received coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or medical therapy (MT) alone reasonably.
RESULTS: An elevated TyG index was defined as the TyG index greater than 9.51. During a median follow-up of 7.5 years, an elevated TyG index was significantly associated with an increased risk of MACE (adjusted hazard ratio 1.161, 95% confidence interval 1.026-1.314, p = 0.018). The elevated TyG index was shown to have a more pronounced predictive value for MACE in patients with diabetes, but failed to predict MACE among those without diabetes, whether they presented with stable angina pectoris (SAP) or acute coronary syndrome (ACS). Meanwhile, the association between an elevated TyG index and MACE was also found in patients with left main involvement. Notably, CABG conferred a significant survival advantage over PCI in patients with a normal TyG index, but was not observed to be superior to PCI in patients with an elevated TyG index unless the patients had both ACS and diabetes. In addition, the benefit was shown to be similar between MT and revascularisation among patients with SAP and an elevated TyG index.
CONCLUSIONS: The TyG index is a potential indicator for risk stratification and therapeutic decision-making in patients with TVD.

Keywords

Diabetes Insulin resistance Revascularisation strategy Three-vessel disease Triglyceride-glucose index

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Grants

  1. Z191100006619106/The Beijing Municipal Science and Technology Commission
  2. 2023-I2M-1-001/The CAMS Innovation Fund for Medical Sciences
  3. 2022-GSP-GG-17/The National High Level Hospital Clinical Research Funding

MeSH Term

Humans
Insulin Resistance
Percutaneous Coronary Intervention
Vascular Diseases
Risk Factors
Acute Coronary Syndrome
Angina, Stable
Glucose
Triglycerides
Diabetes Mellitus
Blood Glucose
Biomarkers
Risk Assessment

Chemicals

Glucose
Triglycerides
Blood Glucose
Biomarkers
Journal Article Research Support, Non-U.S. Gov't
Article has an altmetric score of 1

Word Cloud

Created with Highcharts 10.0.0indexTyGpatientselevatedMACEresistanceriskdiseaseTVDcoronaryPCIdiabetesInsulintriglyceride-glucosestudyvaluetherapythree-vesseladverseCABGMT1shownamongSAPACSstrategyBACKGROUND:pivotalfactorcardiovasculardiseaseswell-establishedsurrogateinsulinaimedinvestigateprognosticabilityguidanceMETHODS:total8862availablebaselinedataincludedendpointmajorcardiaceventsreceivedarterybypassgraftingpercutaneousinterventionmedicalalonereasonablyRESULTS:definedgreater951medianfollow-up75 yearssignificantlyassociatedincreasedadjustedhazardratio16195%confidenceinterval026-1314p = 0018pronouncedpredictivefailedpredictwithoutwhetherpresentedstableanginapectorisacutesyndromeMeanwhileassociationalsofoundleftmaininvolvementNotablyconferredsignificantsurvivaladvantagenormalobservedsuperiorunlessadditionbenefitsimilarrevascularisationCONCLUSIONS:potentialindicatorstratificationtherapeuticdecision-makingpredictsoutcomesinteractstreatmentDiabetesRevascularisationThree-vesselTriglyceride-glucose

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