What is the clinical evidence from this study?

Study design: Cohort. Population: Acute coronary syndrome (ACS) with LDL-C below 1.8 mmol/L in nondiabetic patients (n=1655). Intervention: High triglyceride-glucose (TyG) index (≥8.33) vs. Low TyG index (<8.33). Primary outcome: Revascularization (HR 1.67, 95% CI 1.02-2.75, p=0.043).

February 2, 2021Open Access

High Triglyceride-Glucose Index is Associated with Poor Cardiovascular Outcomes in Nondiabetic Patients with ACS with LDL-C below 1.8 mmol/L

Q: What are the key findings of this study?

In nondiabetic patients with acute coronary syndrome and LDL-C below 1.8 mmol/L, a high triglyceride-glucose index (≥8.33) was associated with a significantly higher risk of subsequent revascularization (HR 1.67).

Key Result

In nondiabetic patients with acute coronary syndrome and LDL-C below 1.8 mmol/L, a high triglyceride-glucose index (≥8.33) was associated with a significantly higher risk of subsequent revascularization (HR 1.67).

Study Design

Type

Cohort (n=1,655)

Multicenter

Structured PICO

Does a high Triglyceride-Glucose (TyG) index predict poor cardiovascular outcomes in nondiabetic patients with ACS and LDL-C < 1.8 mmol/L?

Population

1,655 nondiabetic patients with acute coronary syndrome (ACS) undergoing coronary angiography with LDL-C < 1.8 mmol/L. Mean age 63.9-67.4 years, 73.1-74.7% male, based in China. Key exclusions: diabetes mellitus, LDL-C ≥ 1.8 mmol/L, severe valvulopathy or cardiomyopathy, acute infectious/rheumatic/hematological/neoplastic disease.

Intervention

High Triglyceride-Glucose (TyG) index (≥ 8.33)

Comparator

Low Triglyceride-Glucose (TyG) index (< 8.33)

Outcome

Major adverse cardiac and cerebral event (MACCE), a composite of all-cause death, nonfatal MI, nonfatal stroke, revascularization, and cardiac rehospitalization during a median 35.6-month follow-upcomposite

In nondiabetic patients with ACS and well-controlled LDL-C, a high TyG index is an independent predictor of subsequent revascularization and larger infarct size.

Main Result

Effect estimate: HR 1.67 (95% CI 1.02-2.75)

Absolute Event Rate: 8.9% vs 5%

p-value: p=0.043

Limitations

Single-center study with potentially insufficient sample size and follow-up time
Laboratory parameters were only measured once after hospital admission, which could cause potential bias due to measurement error
Retrospective observational design
Limited information on the levels of the TyG index during follow-up

Abstract

AIM: To evaluate the prognostic value of triglyceride-glucose (TyG) index in nondiabetic patients with acute coronary syndrome (ACS) with low-density lipoprotein cholesterol (LDL-C) below 1.8 mmol/L. METHODS: A total of 1655 nondiabetic patients with ACS with LDL-C below 1.8 mmol/L were included in the analysis. Patients were stratified into two groups. The incidence of acute myocardial infarction (AMI), infarct size in patients with AMI, and major adverse cardiac and cerebral event during a median of 35.6-month follow-up were determined and compared between the two groups. The TyG index was calculated using the following formula: ln fasting triglycerides (mg/dL)×fasting plasma glucose (mg/dL)/2. RESULTS: Compared with the TyG index ＜8.33 group, the TyG index ≥ 8.33 group had a significantly higher incidence of AMI (21.2% vs. 15.2%, p=0.014) and larger infarct size in patients with AMI the peak value of troponin I: 10.4 vs. 4.8 ng/ml, p=0.003; the peak value of Creatine kinase MB: 52.8 vs. 22.0 ng/ml, p=0.006; the peak value of myoglobin: 73.7 vs. 46.0 ng/ml, p=0.038. Although there was no significant difference in mortality between the two groups, the incidence of revascularization of the TyG index ≥ 8.33 group was significantly higher than that of the TyG index ＜8.33 group (8.9% vs. 5.0%, p=0.035). A multivariable Cox regression revealed that the TyG index was positively associated with revascularization hazard ratio, 1.67; 95% confidence interval, 1.02-2.75; p=0.043. CONCLUSIONS: In nondiabetic patients with ACS with LDL-C below 1.8 mmol/L, a high TyG index level was associated with higher incidence of AMI, larger infarct size, and higher incidence of revascularization. A high TyG index level might be a valid predictor of subsequent revascularization.

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