The TyG index demonstrated superior predictive performance for MACE (AUC 0.62) and significantly enhanced the GRACE score's predictive capacity (cNRI = 0.137) in patients with AMI and CKD.
Cohort (n=1,803)
Do insulin resistance indices improve the prediction of major adverse cardiovascular events over the GRACE score in patients with acute myocardial infarction and chronic kidney disease?
Incorporating the TyG index significantly enhances the GRACE score's ability to predict MACE in patients with both AMI and CKD.
Effect estimate: AUC 0.62
p-value: p=< 0.001
BACKGROUND: Patients with both acute myocardial infarction (AMI) and chronic kidney disease (CKD) face a markedly poor prognosis, a key driver of which is insulin resistance (IR). This study aims to systematically evaluate and compare the predictive performance of four commonly used IR indices for major adverse cardiovascular events (MACE), and to assess their incremental value over the GRACE score in this patient group. METHODS: This retrospective cohort study analyzed 1,803 patients with AMI and CKD. Multivariable Cox regression determined associations between IR indices and MACE. Predictive performance was evaluated using C-statistics, continuous net reclassification improvement (cNRI), and integrated discrimination improvement (IDI). RESULTS: < 0.001). The Area Under the Curve (AUCs) for MACE prediction were: TyG index 0.62, AIP 0.57, TyG-BMI 0.58, and METS-IR 0.56. Incorporating IR indices significantly enhanced the GRACE score's predictive capacity, with TyG index providing the greatest incremental improvement (cNRI = 0.137, IDI = 0.03). CONCLUSION: IR indices predict outcomes in patients with AMI and CKD and enhance GRACE score prediction, with TyG index demonstrating superior performance.
Ni et al. (Thu,) conducted a cohort in acute myocardial infarction and chronic kidney disease (n=1,803). Insulin resistance indices (TyG index, AIP, TyG-BMI, METS-IR) vs. GRACE score was evaluated on Major adverse cardiovascular events (MACE) (AUC 0.62, p=< 0.001). The TyG index demonstrated superior predictive performance for MACE (AUC 0.62) and significantly enhanced the GRACE score's predictive capacity (cNRI = 0.137) in patients with AMI and CKD.