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Triglyceride-glucose index is associated with in-stent restenosis in patients with acute coronary syndrome after percutaneous coronary intervention with drug-eluting stents
Cardiovascular Diabetology ( IF 9.3 ) Pub Date : 2021-07-08 , DOI: 10.1186/s12933-021-01332-4
Yong Zhu 1 , Kesen Liu 1 , Maolin Chen 2 , Yan Liu 1 , Ang Gao 1 , Chengping Hu 1 , Hong Li 1 , Huagang Zhu 1 , Hongya Han 1 , Jianwei Zhang 1 , Yingxin Zhao 1
Affiliation  

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. 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. 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). 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.

中文翻译:

药物洗脱支架经皮冠状动脉介入治疗后急性冠脉综合征患者甘油三酯-葡萄糖指数与支架内再狭窄相关

甘油三酯-葡萄糖 (TyG) 指数是胰岛素抵抗 (IR) 的替代标志物,与动脉粥样硬化性心血管疾病 (ASCVD) 的患病率和预后密切相关。然而,急性冠脉综合征 (ACS) 患者药物洗脱支架 (DES) 植入后 TyG 指数与支架内再狭窄 (ISR) 之间的关联仍然未知。本研究回顾性招募了因 ACS 入院并在基于 DES 的经皮冠状动脉介入治疗 (PCI) 成功后 6 至 24 个月接受冠状动脉造影的患者。此外,我们采用以下公式计算TyG指数:Ln(空腹甘油三酯[mg/dL]×空腹血糖[mg/dL]/2),并根据TyG指数的三分位数将患者分为3组。最重要的是,还构建了多变量逻辑回归分析模型来评估 ACS 患者中 TyG 指数与 DES-ISR 之间的关联。本研究共纳入 1574 名 ACS 患者(58.4 ± 9.4 岁,77.4% 为男性)。在中位随访 12 (9-14) 个月时,DES-ISR 的患病率随着 TyG 指数三分位数的增加而逐步增加(11.6% vs 17.3% vs 19.4%,p = 0.002),TyG ISR 组的指数也高于非 ISR 组(9.00 ± 0.58 vs 8.84 ± 0.61,p < 0.001)。此外,TyG 指数与 DES-ISR 患病率之间的正相关也在完全调整的模型中确定(TyG,每增加 1 个单位:OR 1.424,95% CI 1.116 至 1.818,p = 0.005; TyG,第 2 分位数和第 3 分位数的 OR(95% CI)值为 1.454(1.013 至 2.087)和 1。634(1.125 到 2.374),以三分位数 1 作为参考)。这种关联也反映在大多数亚组中。此外,将 TyG 指数添加到 ACS 患者 DES-ISR 的预测模型中可能有助于增加 C 统计量(0.675 对 0.659,p = 0.010)、分类净重分类改善(0.090,p < 0.001)和综合歧视改善(0.004,p = 0.040)。在接受 PCI 的 ACS 患者中,TyG 指数升高与 DES-ISR 独立且正相关。然而,TyG 指数对 DES-ISR 的增量预测值很小。为了进一步证实我们的发现,需要进一步的研究。将 TyG 指数添加到 ACS 患者的 DES-ISR 预测模型中可能有助于增加 C 统计量(0.675 对 0.659,p = 0.010)、分类净重分类改进(0.090,p < 0.001)和综合歧视改善(0.004,p = 0.040)。在接受 PCI 的 ACS 患者中,TyG 指数升高与 DES-ISR 独立且正相关。然而,TyG 指数对 DES-ISR 的增量预测值很小。为了进一步证实我们的发现,需要进一步的研究。将 TyG 指数添加到 ACS 患者的 DES-ISR 预测模型中可能有助于增加 C 统计量(0.675 对 0.659,p = 0.010)、分类净重分类改进(0.090,p < 0.001)和综合歧视改善(0.004,p = 0.040)。在接受 PCI 的 ACS 患者中,TyG 指数升高与 DES-ISR 独立且正相关。然而,TyG 指数对 DES-ISR 的增量预测值很小。为了进一步证实我们的发现,需要进一步的研究。在接受 PCI 的 ACS 患者中,TyG 指数升高与 DES-ISR 独立且正相关。然而,TyG 指数对 DES-ISR 的增量预测值很小。为了进一步证实我们的发现,需要进一步的研究。在接受 PCI 的 ACS 患者中,TyG 指数升高与 DES-ISR 独立且正相关。然而,TyG 指数对 DES-ISR 的增量预测值很小。为了进一步证实我们的发现,需要进一步的研究。
更新日期:2021-07-08
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