Impact of Insulin Resistance on Post-Procedural Myocardial Injury and Clinical Outcomes in Patients Who Underwent Elective Coronary Interventions With Drug-Eluting Stents

Uetani, Tadayuki; Amano, Tetsuya; Harada, Kazuhiro; Kitagawa, Kakuya; Kunimura, Ayako; Shimbo, Yusaku; Harada, Ken; Yoshida, Tomohiro; Kato, Bunichi; Kato, Masataka; Marui, Nobuyuki; Nanki, Michio; Hotta, Nigishi; Ishii, Hideki; Matsubara, Tatsuaki; Murohara, Toyoaki

doi:10.1016/j.jcin.2012.07.008

Cited by 58 publications

(39 citation statements)

References 35 publications

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“…This is concluded from the marked reduction in stroke volume and increased LVEDP and mortality rate. A clinical study previously reported that coronary heart disease patients who had the higher level of homeostasis model assessment of insulin resistance (HOMA) index associated with the increased level of myocardial injury, as well as the higher risk of cardiovascular events and death, after receiving percutaneous coronary interventions23. Interestingly, the increased level of glucose intolerance and the higher HOMA index is associated with increased LV mass only in women24.…”

Section: Discussionmentioning

confidence: 99%

DPP-4 Inhibitor and Estrogen Share Similar Efficacy Against Cardiac Ischemic-Reperfusion Injury in Obese-Insulin Resistant and Estrogen-Deprived Female Rats

Sivasinprasasn

Tanajak

Pongkan

et al. 2017

Sci Rep

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Estrogen deprivation aggravates cardiac injury after myocardial ischemia and reperfusion (I/R) injury. Although either estrogen or the dipeptidyl peptidase-4 (DPP-4) inhibitor, vildagliptin, reduces myocardial damage following cardiac I/R, their effects on the heart in obese-insulin resistant and estrogen deprived conditions remain unknown. Ovariectomized (O) rats (n = 36) were divided to receive either normal diet (NDO) or high-fat diet (HFO) for 12 weeks, followed by treatment with a vehicle, estrogen or vildagliptin for 4 weeks. The setting of in vivo cardiac I/R injury, 30-min ischemia and 120-min reperfusion, was performed. At 12 weeks after ovariectomy, both NDO and HFO rats exhibited an obese-insulin resistant condition. Both NDO and HFO rats treated with estrogen and vildagliptin showed reduced fasting plasma glucose, insulin and HOMA index. Both treatments improved cardiac function indicated by restoration of heart rate variability and increased %left ventricular ejection fraction (%LVEF). The treatments similarly protected cardiac mitochondrial function against I/R injury, leading to a reduction in the infarct size, oxidative stress and apoptosis in the ischemic myocardium. These findings demonstrate that vildagliptin effectively improves metabolic status, and shares similar efficacy to estrogen in reducing myocardial infarction and protecting cardiac mitochondrial function against I/R injury in estrogen-deprived obese-insulin resistant rats.

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Section: Discussionmentioning

confidence: 99%

DPP-4 Inhibitor and Estrogen Share Similar Efficacy Against Cardiac Ischemic-Reperfusion Injury in Obese-Insulin Resistant and Estrogen-Deprived Female Rats

Sivasinprasasn

Tanajak

Pongkan

et al. 2017

Sci Rep

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“…IR not only contributes to the development of CVD in both the general population and patients with diabetes, but also predicts cardiovascular outcomes in patients with CVD [27][28]. Therefore, identification of IR will have great clinical signification to improve cardiovascular risk stratification in primary and secondary prevention.…”

Section: Baseline Characteristics Of Patientsmentioning

confidence: 99%

Triglyceride-glucose index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome

Wang

Cong

Zhang

et al. 2020

Preprint

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Background: Triglyceride-glucose index (TyG index) has been regarded as a reliable alternative marker of insulin resistance and an independent predictor of cardiovascular outcomes. Whether TyG index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome (ACS) remains uncertain. The aim of the present study was to investigate the prognostic value of TyG index in patients with diabetes and ACS.Methods: A total of 2531 consecutive patients with diabetes who underwent coronary angiography for ACS were enrolled in the study. Patients were divided into 3 tertiles according to TyG index. The primary outcomes included the occurrence of major adverse cardiovascular events (MACE), defined as all-cause death, non-fatal myocardial infarction and non-fatal stroke. The TyG index was calculated as ln (fasting triglyceride level (mg/dL) ×fasting glucose level (mg/dL)/2).Results: The incidence of MACE increased with TyG index tertiles after 3-year follow-up. Kaplan-Meier curves showed significant differences in event-free survival rates among TyG index tertiles (P=0.005).Multivariate Cox hazards regression analysis revealed that TyG index was an independent predictor of MACE (95% CI 1.201-1.746; P<0.001). The optimal TyG index cut-off for predicting MACE was 9.323 (sensitivity 46.0% ; specificity 63.6%; area under the curve 0.560; P=0.001 ).Furthermore, adding TyG index to the prognostic model for MACE improved the C-statistic value (P=0.010), the integrated discrimination improvement value(P=0.001) and the net reclassification improvement value(P=0.019).Conclusions TyG index predicts future recurrent cardiovascular events in patients with diabetes and ACS, independently of known cardiovascular risk factors suggesting that TyG index may be a useful marker for risk stratification and prognosis in patients with diabetes and ACS.

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“…Insulin resistance (IR), the critical mechanism of the pathogenesis of T2DM, has been extensively demonstrated to be signi cantly related to the development of coronary and carotid atherosclerosis and an increased risk of adverse prognosis [7][8][9][10]. The triglyceride-glucose index (TyG index), which is derived from fasting triglycerides (TGs) and fasting blood glucose (FBG), has been proposed as a surrogate biomarker of IR and former studies have proved that it has high correlation with hyperinsulinaemiceuglycaemic clamp (the gold standard technique for assessing IR), either in individuals with or without T2DM [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Impacts of triglycerides-glucose index on prognosis of patients with type 2 diabetes mellitus and non-ST-segment elevation acute coronary syndrome: results from an observational cohort study in China

Zhao

Zhang

Cheng

et al. 2020

Preprint

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Background: The relationship between triglycerides-glucose index (TyG index) and the prevalence and prognosis of cardiovascular disease has been confirmed by former studies. However, it remains uncertain whether TyG index has a prognostic impact in patients with type 2 diabetes mellitus (T2DM) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS) undergoing percutaneous coronary intervention (PCI).Methods: The study retrospectively enrolled 798 patients (mean age: 60.9 ± 8.3 years; 68.3% men) with T2DM and NSTE-ACS who underwent PCI at Beijing Anzhen Hospital from January to December 2015. TyG index was calculated as previously reported: ln [fasting TGs (mg/dL) * FBG (mg/dL) / 2]. The primary endpoint was a composite of adverse events as follows: all-cause death, non-fatal myocardial infarction (MI) and ischemia-driven revascularization.Results: TyG index were significantly higher in patients with a primary endpoint event compared with those without. Multivariate Cox analysis showed that 1-unit increase of TyG index was independently associated with higher risk of primary endpoint, independent of other risk factors [hazard ratio (HR) 3.208 per 1-unit increase, 95% confidence interval (CI) 2.400-4.289, P < 0.001]. The addition of TyG index to a baseline risk model had an incremental effect on the predictive value for adverse prognosis [AUC: baseline risk model, 0.800 vs. baseline risk model + TyG index, 0.856, P for comparison < 0.001; category-free net reclassification improvement (NRI) 0.346, P < 0.001; integrated discrimination improvement (IDI) 0.087, P < 0.001].Conclusions: Increased TyG index is a significant predictor of adverse prognosis in patients with T2DM and NSTE-ACS undergoing PCI. Further studies need to be performed to determine whether interventions for TyG index have a positive impact on improving clinical prognosis.

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Impact of Insulin Resistance on Post-Procedural Myocardial Injury and Clinical Outcomes in Patients Who Underwent Elective Coronary Interventions With Drug-Eluting Stents

Abstract: These results indicated the impact of insulin resistance on post-procedural myocardial injury and clinical outcome after elective PCI with drug-eluting stent deployment. Evaluation of insulin resistance may provide useful information for predicting clinical outcomes after elective PCI.

Cited by 58 publications

References 35 publications

DPP-4 Inhibitor and Estrogen Share Similar Efficacy Against Cardiac Ischemic-Reperfusion Injury in Obese-Insulin Resistant and Estrogen-Deprived Female Rats

DPP-4 Inhibitor and Estrogen Share Similar Efficacy Against Cardiac Ischemic-Reperfusion Injury in Obese-Insulin Resistant and Estrogen-Deprived Female Rats

Triglyceride-glucose index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome

Impacts of triglycerides-glucose index on prognosis of patients with type 2 diabetes mellitus and non-ST-segment elevation acute coronary syndrome: results from an observational cohort study in China

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