The middle tertile of the triglyceride glucose index was significantly associated with a higher risk of major adverse cardiovascular events in STEMI patients with plaque rupture (HR 5.45), but not in those with plaque erosion.
Cohort (n=274)
No
Does the triglyceride glucose (TyG) index combined with plaque characteristics predict major adverse cardiovascular events in patients with STEMI undergoing primary PCI?
The combination of microstructural OCT features of culprit lesions and the TyG index can support risk stratification and predict adverse events in patients with STEMI.
Hazard Ratio: 5.45 (95% CI 1.1–27.09)
p-value: p=0.038
BACKGROUND AND AIM: This prospective study explored plaque morphology according to the underlying culprit lesion pathology (rupture versus erosion) in relation to the triglyceride glucose (TyG) index in patients with acute ST-elevated myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention and optical coherence tomography (OCT) for culprit lesions to elucidate the effects of the TyG index and type of plaque on the incidence of major adverse cardiovascular events (MACEs). METHODS AND OUTCOMES: A total of 274 patients with STEMI aged ≥ 18 years who underwent pre-intervention OCT imaging of culprit lesions between March 2017 and March 2019 were enrolled. The TyG index was calculated using the formula lnfasting TG (mg/dL) × fasting glucose (mg/dL)/2. Patients with plaque rupture (PR) and plaque erosion (PE) were divided into three groups across the TyG tertiles. MACEs were defined as a composite of all-cause death, myocardial infarction (MI) recurrence, and ischaemic stroke. In fully adjusted analyses, the middle tertile of TyG was significantly associated with greater rates of MACEs in patients with PR but not in those with PE (relative to the low tertile, HR hazard ratio, 6.01; 95% confidence interval CI, 1.25-28.88; P = 0.025). Cox regression models indicated a significantly higher HR for MACEs in patients in the middle tertile of TyG than in those in the low tertile of TyG after full additional adjustment (HR, 5.45; 95% CI, 1.10-27.09; P = 0.038). However, being in the high tertile of TyG independently and significantly increased the risk of major bleeding events among patients with PE (HR, 2.50; 95% CI, 1.11-5.65; P = 0.028). The area under the receiver operating characteristic curve for predicting MACEs to evaluate the diagnostic value of the TyG index combined with the morphological characteristics of plaque after full adjustment was 0.881 (sensitivity = 94.74%, specificity = 78.04%, cut-off level = 0.73). Kaplan-Meier curves were generated for the cumulative incidence of MACEs for up to a median of 1.98 years stratified by tertiles of TyG among the PR and PE subgroups. Among patients with PR, there were significant differences among the tertiles of TyG (p = 0.030). CONCLUSION AND RELEVANCE: Microstructural OCT features of culprit lesions in combination with the TyG index, a surrogate estimate of insulin resistance, can be used in clinical practice to support risk stratification and predict adverse events in patients with STEMI.
Zhao et al. (Mon,) conduziram uma coorte em infarto do miocárdio com elevação do segmento ST (STEMI) (n=274). O índice de glicose de triglicerídeos (TyG) versus o baixo tercil do índice de TyG foi avaliado nos eventos cardiovasculares adversos maiores (MACEs), uma composição de morte por todas as causas, recidiva de infarto do miocárdio e acidente vascular cerebral isquêmico (HR 5,45, IC 95% 1,10-27,09, p=0,038). O tercil médio do índice de glicose de triglicerídeos foi significativamente associado a um maior risco de eventos cardiovasculares adversos maiores em pacientes com STEMI com ruptura de placa (HR 5,45), mas não naqueles com erosão de placa.