What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction complicated by cardiogenic shock (n=5208). Intervention: Elevated Triglyceride-glucose (TyG) index (Tertile 3) vs. Lowest Triglyceride-glucose (TyG) index (Tertile 1). Primary outcome: In-hospital mortality (OR 2.544, 95% CI 1.362-4.754, p=0.003).

What does this research mean for the field?

An elevated triglyceride-glucose (TyG) index is significantly associated with the occurrence of cardiogenic shock and increased in-hospital mortality in patients with acute myocardial infarction. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

September 11, 2024Open Access

Triglyceride-glucose index correlates with the occurrence and prognosis of acute myocardial infarction complicated by cardiogenic shock: data from two large cohorts

HLHuiruo LiuCapital Medical University LWLiangshan WangCapital University XZXing ZhouChina Pharmaceutical University

Key Result

An elevated triglyceride-glucose index was significantly associated with increased in-hospital mortality (OR 2.544) in patients with acute myocardial infarction complicated by cardiogenic shock.

Study Design

Type

Cohort (n=5,208)

Multicenter

Yes

Structured PICO

Does an elevated Triglyceride-glucose (TyG) index correlate with the incidence and prognosis of acute myocardial infarction complicated by cardiogenic shock?

Population

5208 patients with acute myocardial infarction (AMI), including 375 who developed cardiogenic shock (CS), from the eICU Collaborative Research Database and MIMIC-IV.

Intervention

Elevated Triglyceride-glucose (TyG) index

Comparator

Lower TyG index

Outcome

Incidence of cardiogenic shock following AMI, and in-hospital and ICU mortalityhard clinical

An elevated TyG index is associated with a higher incidence of cardiogenic shock and increased in-hospital and ICU mortality in patients with acute myocardial infarction.

Main Result

Effect estimate: OR 2.544 (95% CI 1.362-4.754)

Absolute Event Rate: 38.4% vs 21.6%

p-value: p=0.003

Limitations

Retrospective design limits control over the temporal sequence of events, precluding the establishment of a definitive causal relationship.
Potential unmeasured confounders such as no-reflow events, door-to-balloon time, and AMI location.
Grounded in historical data which may exhibit slight variations from current clinical practices.
Relatively low diagnostic specificity value of the TyG index for a specific pathological setting.
Lack of long-term follow-up data to assess long-term cardiovascular outcomes.

Abstract

BACKGROUND: Triglyceride-glucose (TyG) index, a dependable indicator of insulin resistance, has been identified as a valid marker regarding multiple cardiovascular diseases. Nevertheless, the correlation of TyG index with acute myocardial infarction complicated by cardiogenic shock (AMICS) remains uncertain. Our study aims for elucidating this relationship by comprehensively analyzing two large-scale cohorts. METHODS: Utilizing records from the eICU Collaborative Research Database and the Medical Information Mart for Intensive Care IV, the link between TyG and the incidence and prognosis of AMICS was assessed multicentrally and retrospectively by logistic and correlation models, as well as restricted cubic spline (RCS). Propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and overlap weighting (OW) were employed to balance the potential confounders. Subgroup analyses were performed according to potential modifiers. RESULTS: Overall, 5208 AMI patients, consisting of 375 developing CS were finally included. The TyG index exhibited an apparently higher level in AMI populations developing CS than in those who did not experienced CS 9.2 (8.8-9.7) vs. 9.0 (8.5-9.5), with a moderate discrimination ability to recognize AMICS from the general AMI (AUC: 0.604). Logistic analyses showed that the TyG index was significantly correlated with in-hospital and ICU mortality. RCS analysis demonstrated a linear link between elevated TyG and increased risks regarding in-hospital and ICU mortality in the AMICS population. An increased mortality risk remains evident in PSM-, OW- and IPTW-adjusted populations with higher TyG index who have undergone CS. Correlation analyses demonstrated an apparent link between TyG index and APS score. Subgroup analyses presented a stable link between elevated TyG and mortality particularly in older age, females, those who are overweight or hypertensive, as well as those without diabetes. CONCLUSIONS: Elevated TyG index was related to the incidence of CS following AMI and higher mortality risks in the population with AMICS. Our findings pointed a previously undisclosed role of TyG index in regard to AMICS that still requires further validation.

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