Triglyceride-glucose index is associated with in-stent restenosis in patients with acute coronary syndrome after percutaneous coronary intervention with drug-eluting stents

Abstract

Background The triglyceride-glucose (TyG) index is an alternative marker of insulin resistance (IR) and is closely associated with the prevalence and prognosis of atherosclerotic cardiovascular disease (ASCVD). However, the association between the TyG index and in-stent restenosis (ISR) after drug-eluting stent (DES) implantation in patients with acute coronary syndrome (ACS) remains unknown. Methods The present study retrospectively recruited patients who were admitted for ACS and underwent coronary angiography at 6 to 24 months after successful DES-based percutaneous coronary intervention (PCI). In addition, we calculated the TyG index with the following formula: Ln(fasting triglyceride [mg/dL] × fasting blood glucose [mg/dL]/2) and divided patients into 3 groups according to the tertile of the TyG index. Most importantly, multivariate logistic regression analysis models were also constructed to assess the association between the TyG index and DES-ISR in patients with ACS. Results A total of 1574 patients with ACS (58.4 ± 9.4 years, 77.4% male) were included in this study. At the median follow-up time of 12 (9–14) months, the prevalence of DES-ISR increased stepwise with the increasing tertile of the TyG index (11.6% vs 17.3% vs 19.4%, p = 0.002), and the TyG index was also higher in the ISR group than in the non-ISR group (9.00 ± 0.58 vs 8.84 ± 0.61, p < 0.001). In addition, the positive association between the TyG index and the prevalence of DES-ISR was also determined in the fully adjusted model (TyG, per 1-unit increase: OR 1.424, 95% CI 1.116 to 1.818, p = 0.005; tertile of TyG, the OR (95% CI) values for tertile 2 and tertile 3 were 1.454 (1.013 to 2.087) and 1.634 (1.125 to 2.374), respectively, with tertile 1 as a reference). The association was also reflected in most subgroups. Moreover, adding the TyG index to the predictive model for DES-ISR in patients with ACS could contribute to an increase in C-statistics (0.675 vs 0.659, p = 0.010), categorical net reclassification improvement (0.090, p < 0.001), and integrated discrimination improvement (0.004, p = 0.040). Conclusion An elevated TyG index was independently and positively associated with DES-ISR in patients with ACS who underwent PCI. However, the incremental predictive value of the TyG index for DES-ISR was slight. To further confirm our findings, future studies are needed.

Triglyceride-glucose index as a marker in cardiovascular diseases: landscape and limitations

“…Second, regarding the predictive power of the TyG index in CVD, especially in CAD, accumulating studies have shown that the predictive value of the TyG index for CAD is mild to moderate, suggesting that it is difficult to predict severe CVEs based on the TyG index alone. Nevertheless, Wang et al and Zhu et al demonstrated that when introducing the TyG index into an established risk model, TyG could significantly improve the predictive accuracy for MACEs in patients with ACS [ 32 , 39 ]. Thus, routinely adding the TyG index into clinical diagnostic models might help to refine cardiovascular risk stratification and enable the administration of more targeted therapeutics or prevention measures.…”

“…Zhu et al retrospectively recruited 1574 patients who were admitted for ACS and underwent successful drug-eluting stent (DES)-based PCI. They found that an elevated TyG index was independently and positively associated with the occurrence of DES-ISR [ 39 ]. However, the incremental predictive value of the TyG index for DES-ISR was slight; thus, multicentre, large-scale clinical studies are necessary to clarify the relationship between the TyG index and ISR.…”

Triglyceride glucose index exacerbates the risk of future cardiovascular disease due to diabetes: evidence from the China Health and Retirement Longitudinal Survey (CHARLS)

“…Moreover, substantial changes in the TyG index were positively correlated with CVD risk observed in the 62,443 participants without CVD at baseline in China [ 35 ]. In addition, in patients who underwent percutaneous coronary intervention (PCI) after acute coronary syndrome, an elevated TyG index was independently related to in-stent restenosis after drug-eluting stent implantation in the 62,443 general population in China with some predictive value [ 36 ]. The TyG index was significantly associated with future CVD risk in the current study.…”

Prognostic Significance of Triglyceride-Glucose Index for Adverse Cardiovascular Events in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis

“…Several cross-sectional observational studies among the Chinese and Korean populations illustrated that the TyG index was linked to arterial stiffness ( 49 , 50 ). Moreover, an elevated TyG index was positively correlated with in-stent restenosis in patients after drug-eluting stent ( 51 ). These data supported that a high TyG index was closely related to accelerated progression of CAD, cumulatively leading to a high risk of revascularization.…”