Triglyceride glucose index for the detection of the severity of coronary artery disease in different glucose metabolic states in patients with coronary heart disease: a RCSCD-TCM study in China

Abstract

Background: The triglyceride glucose (TyG) index is a new marker associated with atherosclerosis. This study aimed to assess the association between the TyG index and the severity of coronary artery disease (CAD) in patients with coronary heart disease (CHD) and further explore the association between the TyG index and CAD severity in different glucose metabolic states.Methods: This multi-centre retrospective study included 731 CHD patients between September 1, 2014 to September 30, 2020 in China. All patients were stratified into groups based on the tertiles of the TyG index (T1:5.48 ≤ TyG index ≤ 7.17; T2: 7.18 ≤ TyG ≤ 7.76; T3: 7.77 ≤ TyG ≤ 10.82) and the number of diseased vessels [1-vessel disease (VD), 2-VD and 3-VD] represented the severity of CAD. The relationship between the TyG index and CAD severity was analysed using logistic regression. The associations between the TyG index and CAD severity based on different glucose metabolic status were also assessed. Receiver operating characteristic (ROC) curves were performed to evaluate the accuracy of the TyG index for detecting the CAD severity.Results: The baseline analysis results showed significant differences in clinical and biological characteristics of CHD patients according to the TyG index tertiles (P < 0.05 to < 0.001). The TyG index was significantly related to the risk of multiple diseased coronary arteries and more severe coronary stenoses (CS) (P < 0.001). The TyG index was significantly associated with the risk of 3-VD in patients with CHD. The odds ratio (OR) of 3-VD for the TyG index T3 compared to T1 was 2.27 (95% confidence interval [CI] 1.497-3.452; P for trend <0.001). Among different states of glucose metabolism, the association between the TyG index and 3-VD observed was significant in diabetes (OR: 1.662; 95% CI 1.166–2.369). A TyG index threshold for predicting 3-VD (95% [CI] 0.554-0.664; P < 0.001 ) was 7.0 and was 8.1 in diabetes state (95% [CI] 0.523-0.646; P < 0.001 ).Conclusion: The TyG index is associated with CAD severity in CHD patients and an increased TyG index could identify CHD patients with a high risk of 3-VD. The association between the TyG index and CAD severity in the condition of diabetes is higher than in non-diabetes.

Association between the triglyceride–glucose index and severity of coronary artery disease

“…Coronary angiography (CAG) as the gold standard for diagnosing CAD is an accurate and widely used imaging modality that aims to identify the number and degree of coronary artery stenosis. Participants with ≥ 50% lumen stenosis in at least one major coronary artery based on CAG findings were diagnosed with CAD [19]. Furthermore, the severity of CAD was based on the number of stenotic vessels and has a crucial role in the prognosis of CVD.…”

“…Furthermore, the severity of CAD was based on the number of stenotic vessels and has a crucial role in the prognosis of CVD. Participants with multi-vessel CAD are at higher risk for CVD than those with single-vessel CAD, especially those with an abnormal glucose metabolic status [19,20]. A recent study suggested that the TyG index is associated with the risk of multi-vessel CAD for the DM population, but not with that for individuals with prediabetes mellitus (pre-DM) or normoglycemia (NGR) [19].…”

“…Participants with multi-vessel CAD are at higher risk for CVD than those with single-vessel CAD, especially those with an abnormal glucose metabolic status [19,20]. A recent study suggested that the TyG index is associated with the risk of multi-vessel CAD for the DM population, but not with that for individuals with prediabetes mellitus (pre-DM) or normoglycemia (NGR) [19]. However, the results might be attributable to a lack of power because of the small population enrolled in that study.…”

Triglyceride-glucose index is associated with quantitative flow ratio in patients with acute ST-elevation myocardial infarction after percutaneous coronary intervention

“…It has been confirmed that the TyG index can be used as a substitute index for IR, which is a simpler and faster assessment of the body's IR status (13,(25)(26)(27). Several studies have found that the TyG index is significantly associated with the occurrence of atherosclerotic cardiovascular disease (28)(29)(30)(31). A cohort study found that, in long-term follow-up, the TyG index can identify people at high risk for cardiovascular events (28).…”

“…At the same time, a meta-analysis summarizing multiple cohort studies found that after adjusting for the effects of age, gender, and DM, the TyG index was still independently associated with the risk of cardiovascular disease (29). In a RCSCD-TCM study, Su et al conducted a retrospective analysis of 731 patients with CAD and found that the TyG index was associated with the severity of CAD, and an elevated TyG index could increase the risk of coronary multivessel disease (30). Alessandra et al analyzed baseline data from patients in secondary cardiac care and found that the TyG index was associated with metabolic risk factors for the heart, and that a high level of the TyG index was more likely to develop symptomatic CAD (31).…”