Triglyceride glucose index combined with plaque characteristics as a novel biomarker for cardiovascular outcomes after percutaneous coronary intervention in ST-elevated myocardial infarction patients: an intravascular optical coherence tomography study

Abstract

Background and aim This prospective study explored plaque morphology according to the underlying culprit lesion pathology (rupture versus erosion) in relation to the triglyceride glucose (TyG) index in patients with acute ST-elevated myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention and optical coherence tomography (OCT) for culprit lesions to elucidate the effects of the TyG index and type of plaque on the incidence of major adverse cardiovascular events (MACEs). Methods and outcomes A total of 274 patients with STEMI aged ≥ 18 years who underwent pre-intervention OCT imaging of culprit lesions between March 2017 and March 2019 were enrolled. The TyG index was calculated using the formula ln[fasting TG (mg/dL) × fasting glucose (mg/dL)/2]. Patients with plaque rupture (PR) and plaque erosion (PE) were divided into three groups across the TyG tertiles. MACEs were defined as a composite of all-cause death, myocardial infarction (MI) recurrence, and ischaemic stroke. In fully adjusted analyses, the middle tertile of TyG was significantly associated with greater rates of MACEs in patients with PR but not in those with PE (relative to the low tertile, HR [hazard ratio], 6.01; 95% confidence interval [CI], 1.25–28.88; P = 0.025). Cox regression models indicated a significantly higher HR for MACEs in patients in the middle tertile of TyG than in those in the low tertile of TyG after full additional adjustment (HR, 5.45; 95% CI, 1.10–27.09; P = 0.038). However, being in the high tertile of TyG independently and significantly increased the risk of major bleeding events among patients with PE (HR, 2.50; 95% CI, 1.11–5.65; P = 0.028). The area under the receiver operating characteristic curve for predicting MACEs to evaluate the diagnostic value of the TyG index combined with the morphological characteristics of plaque after full adjustment was 0.881 (sensitivity = 94.74%, specificity = 78.04%, cut-off level = 0.73). Kaplan–Meier curves were generated for the cumulative incidence of MACEs for up to a median of 1.98 years stratified by tertiles of TyG among the PR and PE subgroups. Among patients with PR, there were significant differences among the tertiles of TyG (p = 0.030). Conclusion and relevance Microstructural OCT features of culprit lesions in combination with the TyG index, a surrogate estimate of insulin resistance, can be used in clinical practice to support risk stratification and predict adverse events in patients with STEMI.

High triglyceride-glucose index in young adulthood is associated with incident cardiovascular disease and mortality in later life: insight from the CARDIA study

“…In fact, among the four studies they included, two found a statistically significant association between the TyG index and all-cause mortality [ 30 , 31 ], while the other two did not [ 28 , 32 ]. In studies of different populations, most articles found a positive association between the TyG index and cardiovascular mortality/all-cause mortality [ 14 , 33 , 34 ]. Another recent study of the Kangbuk Samsung Health Study cohort [ 35 ], including 255,508 relatively healthy populations, supported that the TyG index is associated with an elevated risk of all-cause and cardiovascular mortality.…”

“…Recently, the triglyceride-glucose (TyG) index, measured by the fasting plasma glucose and triglyceride, has been proposed as a reliable surrogate marker of IR and shown to highly correlate with IR [5,6]. Growing evidence has been demonstrated that the TyG index is related to adverse cardiovascular outcomes in the general population [7][8][9], as well as among certain high-risk patients, such as diabetes [10], hypertension [11], myocardial infarction [12], acute coronary syndrome [13], and after percutaneous coronary intervention [14]. In addition, several studies also report a predictive role of the TyG index with adverse cardiovascular outcomes among the general population [7,15] and patients with cardiovascular diseases [12,13].…”

A High Triglyceride-Glucose Index Value Is Associated With an Increased Risk of Carotid Plaque Burden in Subjects With Prediabetes and New-Onset Type 2 Diabetes: A Real-World Study

“…In the present study, carotid plaque burden was used as a marker of atherosclerosis, which manifested as the change in the plaque score obtained from different carotid districts. As reported in the literature, the prevalence of carotid artery plaque shows a good correlation with the presence of atherosclerosis and can well reflect the overall severity of atherosclerosis in the vasculature ( 25 , 26 ). The association between the TyG index and arteriosclerosis has been demonstrated in some previous studies.…”

“…Research has also shown that the TyG index, as a surrogate for IR, is a marker of the presence of non-calcified or mixed plaques in coronary arteries in asymptomatic individuals (28). Other studies support that a higher TyG index value is associated with the severity of coronary artery stenosis in not only patients with acute ST-elevated myocardial infarction but also asymptomatic patients with T2D (26,29). However, their focus of these studies falls outside the areas of carotid arteries.…”

Association between apolipoprotein B/A1 ratio and coronary plaque vulnerability in patients with atherosclerotic cardiovascular disease: an intravascular optical coherence tomography study

“…Another study indicated that a low ratio of eicosapentaenoic acid to arachidonic acid was associated with higher vulnerability of coronary plaques to rupture [ 40 ]. The triglyceride glucose index combined with the morphological characteristics of plaque could be used to predict adverse events in patients with STEMI [ 41 ]. The combination of different biomarkers, such as soluble lectin-like oxidized LDL receptor-1, MMP-9, WBC count, and peak creatine kinase-MB, could also be used to identify plaque rupture compared with other individual biomarkers in patients with ACS [ 18 ].…”