What is the clinical evidence from this study?

Study design: Cohort. Population: Nondiabetic patients undergoing percutaneous coronary intervention (n=5489). Intervention: Triglyceride-Glucose (TyG) index vs. Lower TyG index tertiles. Primary outcome: Major adverse cardiovascular and cerebrovascular events (MACCE) (HR 0.77, 95% CI 0.56-1.16, p=0.210).

August 19, 2021Open Access

The Impact of the Triglyceride-Glucose Index on Poor Prognosis in NonDiabetic Patients Undergoing Percutaneous Coronary Intervention

Q: What does this research mean for the field?

The triglyceride-glucose (TyG) index is not independently associated with major adverse cardiovascular and cerebrovascular events in nondiabetic patients undergoing percutaneous coronary intervention, though it may have predictive value in those with LDL-C below 1.8 mmol/L. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

The TyG index was not independently associated with major adverse cardiovascular and cerebrovascular events in nondiabetic patients undergoing percutaneous coronary intervention (HR 0.77, P=0.210).

Study Design

Type

Cohort (n=5,489)

Multicenter

Structured PICO

Does the triglyceride-glucose (TyG) index predict major adverse cardiovascular and cerebrovascular events in nondiabetic patients undergoing percutaneous coronary intervention?

Population

5,489 nondiabetic patients with coronary artery disease who underwent percutaneous coronary intervention (PCI), mean age 57.20 years, 79.4% male, based in China. Key exclusions: previous or new diagnosis of diabetes mellitus, use of oral hypoglycemic drugs/liraglutide/insulin, HbA1c ≥6.5%, fasting blood glucose ≥7.0 mmol/L, age >80 years, cardiogenic shock, severe renal insufficiency (creatinine clearance <30 ml/min/m2), and extreme obesity (BMI >45 kg/m2).

Intervention

Triglyceride-glucose (TyG) index, calculated as ln(fasting triglyceride [mg/dl] × fasting blood glucose [mg/dl]/2), evaluated as an exposure variable and divided into tertiles.

Comparator

Comparison among three groups based on admission tertiles of the TyG index: group 1 (TyG index < 8.52), group 2 (8.52 ≤ TyG index < 8.92), and group 3 (TyG index ≥ 8.92).

Outcome

Major adverse cardiovascular and cerebrovascular events (MACCE), a composite of all-cause death, nonfatal myocardial infarction (MI), nonfatal stroke, and target vessel revascularization (TVR) at a median 29.0 months follow-up.composite

The TyG index does not independently predict adverse cardiovascular outcomes in nondiabetic patients undergoing PCI, though it may have predictive value in the subgroup with LDL-C < 1.8 mmol/L.

Main Result

Effect estimate: HR 0.77 (95% CI 0.56-1.16)

p-value: p=0.210

Limitations

Single-center study
Enrolled patients were all Chinese
Did not record abdominal circumference, hip circumference, or nonalcoholic fatty liver disease (NAFLD)
TyG index was recorded only at the time of hospitalization, with no follow-up data to assess long-term insulin resistance levels

Abstract

Background The triglyceride-glucose index (TyG index) is a valuable marker for predicting adverse cardiovascular events in diabetic patients. However, for nondiabetic patients, whether the TyG index is independently related to poor prognosis remains unclear. This cohort study assessed the association of the TyG index with future cardiovascular risk in nondiabetic subjects who received percutaneous coronary intervention (PCI). Methods We consecutively enrolled 5,489 nondiabetic patients who underwent PCI. All experimental subjects were divided into three groups based on their TyG index, which was determined by the equation ln (fasting triglyceride (mg/dl) × fasting blood glucose (mg/dl)/2). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including all-cause death, nonfatal myocardial infarction (MI), nonfatal stroke, and target vessel revascularization (TVR). Results A total of 386 MACCE were documented during a median 29-month follow-up. The Kaplan–Meier survival results indicated that among the three groups, there was no obvious difference in any endpoints. Further Cox regression analyses suggested that the TyG index was not independently related to adverse cardiovascular outcomes for nondiabetic patients who underwent PCI (HR: 0.77, 95% CI 0.56–1.16, P = 0.210 for MACCE). Subgroup analysis suggested that the TyG index was independently relevant to MACCE for patients with low-density lipoprotein cholesterol (LDL-C) lower than 1.8 mmol/L. Conclusion The TyG index is not an effective predictive factor for adverse cardiovascular prognosis in nondiabetic patients who underwent PCI. However, in subjects with LDL-C lower than 1.8mmol/L, it may predict future cardiovascular risk.

Bookmark

View Full Paper