Key result
The addition of the atherogenic index of plasma (AIP) or triglyceride-glucose (TyG) index to a baseline clinical model significantly improved discrimination for in-stent restenosis occurrence, increasing the AUC by 0.056 and 0.040, respectively.
Why the study?
The comparative associations of commonly used metabolic indices with in-stent restenosis and its angiographic severity remain incompletely characterized within the same patient population.
Do metabolic indices (TyG, AIP, METS-IR) improve discrimination of angiographically detected in-stent restenosis in adult patients with prior drug-eluting stent implantation?
Case-Control (n=774)
No
Do metabolic indices (TyG, AIP, METS-IR) improve discrimination of angiographically detected in-stent restenosis in adult patients with prior drug-eluting stent implantation?
Effect estimate: ΔAUC +0.056 (95% CI 0.031-0.116)
p-value: p=<0.001
The TyG index and AIP provide incremental discriminatory value for predicting in-stent restenosis after drug-eluting stent implantation beyond traditional clinical factors, whereas METS-IR does not.
Background Metabolic abnormalities may contribute to in-stent restenosis (ISR) after percutaneous coronary intervention, but the comparative associations of commonly used metabolic indices with ISR within the same patient population remain incompletely characterized. Objective To compare the associations of the triglyceride-glucose (TyG) index, atherogenic index of plasma (AIP), and metabolic score for insulin resistance (METS-IR) with angiographically detected ISR and its severity, and to explore potential heterogeneity according to sex and clinical presentation. Design Retrospective, propensity-score-matched case-control study of patients undergoing follow-up coronary angiography between 2019 and 2024. Participants The propensity-score-matched cohort comprised 774 patients, including 387 patients with ISR and 387 matched controls without ISR. Angiographic severity analyses were performed among the 387 matched patients with ISR. Main measures TyG, AIP, and METS-IR were assessed separately in multivariable models. Model discrimination was evaluated using the area under the receiver operating characteristic curve (AUC), paired DeLong testing, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Sex- and clinical-presentation analyses were considered exploratory. Key results The baseline clinical and procedural model yielded an AUC of 0.716 (95% CI 0.672–0.763) for ISR occurrence. Addition of TyG increased the AUC to 0.756 (95% CI 0.708–0.803; ΔAUC +0.040; paired DeLong p=0.003), while addition of AIP increased the AUC to 0.772 (95% CI 0.726–0.806; ΔAUC +0.056; p<0.001). Addition of METS-IR did not improve discrimination (AUC 0.716, 95% CI 0.671–0.748; p=0.642). Bootstrap analyses supported the incremental discrimination associated with TyG and AIP but not METS-IR. For ISR severity, addition of TyG or AIP produced only modest increases in AUC, neither of which was significant by paired DeLong testing. Formal interaction analyses did not demonstrate significant effect modification by sex, and analyses according to clinical presentation were limited by small subgroup sizes. Conclusions In this retrospective matched cohort, TyG and AIP provided incremental discriminatory information for angiographically detected ISR beyond conventional clinical and procedural factors, whereas METS-IR provided little additional value. Evidence regarding angiographic severity was less robust, and findings across sex and clinical-presentation subgroups should be considered exploratory. Prospective external validation is required before these indices can be considered for clinical risk stratification.
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Lessomo et al. (2026) conducted a case-control in In-stent restenosis after drug-eluting stent implantation (n=774). Atherogenic index of plasma (AIP) and Triglyceride-glucose (TyG) index vs. Baseline clinical and procedural model was evaluated on Discrimination of in-stent restenosis occurrence (AUC) (ΔAUC +0.056, 95% CI 0.031-0.116, p=<0.001). The addition of the atherogenic index of plasma (AIP) or triglyceride-glucose (TyG) index to a baseline clinical model significantly improved discrimination for in-stent restenosis occurrence, increasing the AUC by 0.056 and 0.040, respectively.
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