What is the clinical evidence from this study?

Study design: Cohort. Population: Acute coronary syndrome and diabetes mellitus (n=231). Intervention: Triglyceride-glucose (TyG) index vs. Lowest TyG index tertile (Tertile 1). Primary outcome: All-cause mortality (HR 2.04, 95% CI 1.09, 3.81, p=<0.05).

February 6, 2023Open Access

Triglyceride glucose index predicts all-cause mortality in oldest-old patients with acute coronary syndrome and diabetes mellitus

Q: What are the key findings of this study?

The highest tertile of the Triglyceride-glucose index was associated with a significantly increased risk of all-cause mortality (HR 2.04) compared to the lowest tertile in oldest-old ACS patients with diabetes.

Key Result

The highest tertile of the Triglyceride-glucose index was associated with a significantly increased risk of all-cause mortality (HR 2.04) compared to the lowest tertile in oldest-old ACS patients with diabetes.

Study Design

Type

Cohort (n=231)

Multicenter

Structured PICO

Does a higher TyG index predict increased all-cause mortality in oldest-old patients with ACS and DM?

Population

231 oldest-old patients (aged ≥80 years) with acute coronary syndrome and diabetes mellitus, followed for a median of 49 months.

Exposure

High Triglyceride-glucose (TyG) index (Tertile 3 or per standard deviation increment)

Comparator

Low Triglyceride-glucose (TyG) index (Tertile 1)

Outcome

All-cause mortalityhard clinical

The TyG index is a significant, dose-responsive predictor of all-cause mortality in patients aged 80 and older with acute coronary syndrome and diabetes mellitus, outperforming traditional fasting blood glucose and triglycerides.

Main Result

Hazard Ratio: 2.04 (95% CI 1.09–3.81)

Absolute Event Rate: 48.1% vs 24.7%

p-value: p=<0.05

Limitations

Single-center study with a relatively small sample size
Potential selection bias
No comparative analysis between the TyG index and traditional insulin resistance indicators
Unmeasured confounding factors such as dietary habits and nutritional status

Abstract

BACKGROUND: Acute coronary syndrome (ACS) and diabetes mellitus (DM) are the leading health risks for the elderly. Triglyceride-glucose (TyG) index is a novel and reliable indicator of insulin resistance (IR). This study aims to explore the relationship between the TyG index and all-cause mortality in oldest-old patients with ACS and DM. METHODS: Seven hundred twenty hospitalized patients with ACS aged ≥ 80 years were enrolled, and 699 patients signed informed consent for the study. During the follow-up period, 37 were lost to follow-up, and the follow-up rate was 94.7%. 231 ACS patients with DM were selected for the study's analyses. Kaplan-Meier curve, Cox regression model and receiver operating characteristic (ROC) curve were used to analyze the association between the TyG index and all-cause mortality. RESULTS: The mean age of participants was 81.58 ± 1.93 years, and 32.47% were women. Compared to TyG tertile 1, the Hazard Ratio (HR) 95% confidence interval (CI) of all-cause mortality was 2.04 (1.09, 3.81) for TyG tertile 3 in the fully adjusted model. For the TyG index per standard deviation (SD) increment, the HR (95% CI) of all-cause mortality was 1.44 (1.13, 1.83). Further, the association between the TyG index and all-cause mortality was dose-response (P for trend = 0.026). ROC curve analyses indicated that the TyG index outperformed FBG and TG in the prediction of mortality risk and improved the prognostic value of the Gensini score combined with LVEF. CONCLUSION: The TyG index predicts the risk of all-cause mortality in the oldest-old ACS patients with DM.

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