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High Triglyceride-Glucose Index is Associated with Poor Cardiovascular Outcomes in Nondiabetic Patients with ACS with
Yue Zhang1, Xiaosong Ding1, Bing Hua1
1Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University.
Insights
A high triglyceride-glucose (TyG) index predicts increased risk of acute myocardial infarction (AMI) and larger infarct size in non-diabetic acute coronary syndrome (ACS) patients. It also indicates a higher likelihood of needing revascularization.
Area of Science:
- Cardiology
- Metabolic Syndrome
- Biomarkers
Background:
- The triglyceride-glucose (TyG) index is a marker of insulin resistance.
- Nondiabetic patients with acute coronary syndrome (ACS) and low low-density lipoprotein cholesterol (LDL-C) present unique challenges in risk stratification.
- Identifying reliable prognostic markers in this population is crucial for optimizing patient management.
Purpose of the Study:
- To investigate the prognostic significance of the TyG index in nondiabetic patients with ACS and LDL-C levels below 1.8 mmol/L.
- To determine if the TyG index can predict adverse cardiovascular events, including acute myocardial infarction (AMI) and the need for revascularization.
Main Methods:
- A cohort of 1655 nondiabetic ACS patients with LDL-C < 1.8 mmol/L was analyzed.
- Patients were categorized into two groups based on TyG index levels (≥8.33 vs. <8.33).
- Outcomes including incidence of AMI, infarct size, and major adverse cardiac and cerebral events were compared over a median follow-up of 35.6 months.
Main Results:
- Patients with a higher TyG index (≥8.33) exhibited a significantly higher incidence of AMI (21.2% vs. 15.2%) and larger infarct size, indicated by elevated peak troponin I, creatine kinase-MB, and myoglobin levels.
- While mortality did not differ significantly, the incidence of revascularization was notably higher in the high TyG index group (8.9% vs. 5.0%).
- Multivariable Cox regression confirmed a positive association between the TyG index and revascularization (Hazard Ratio: 1.67, 95% CI: 1.02-2.75).
Conclusions:
- In nondiabetic ACS patients with controlled LDL-C, an elevated TyG index is linked to increased AMI incidence and severity.
- A high TyG index may serve as a valuable predictor for subsequent revascularization procedures in this patient cohort.
Aim:
To evaluate the prognostic value of triglyceride-glucose (TyG) index in nondiabetic patients with acute coronary syndrome (ACS) with low-density lipoprotein cholesterol (LDL-C) below 1.8 mmol/L.
Methods:
A total of 1655 nondiabetic patients with ACS with LDL-C below 1.8 mmol/L were included in the analysis. Patients were stratified into two groups. The incidence of acute myocardial infarction (AMI), infarct size in patients with AMI, and major adverse cardiac and cerebral event during a median of 35.6-month follow-up were determined and compared between the two groups. The TyG index was calculated using the following formula: ln [fasting triglycerides (mg/dL)×fasting plasma glucose (mg/dL)/2].
Results:
Compared with the TyG index ＜8.33 group, the TyG index ≥ 8.33 group had a significantly higher incidence of AMI (21.2% vs. 15.2%, p=0.014) and larger infarct size in patients with AMI [the peak value of troponin I: 10.4 vs. 4.8 ng/ml, p=0.003; the peak value of Creatine kinase MB: 52.8 vs. 22.0 ng/ml, p=0.006; the peak value of myoglobin: 73.7 vs. 46.0 ng/ml, p=0.038]. Although there was no significant difference in mortality between the two groups, the incidence of revascularization of the TyG index ≥ 8.33 group was significantly higher than that of the TyG index ＜8.33 group (8.9% vs. 5.0%, p=0.035). A multivariable Cox regression revealed that the TyG index was positively associated with revascularization [hazard ratio, 1.67; 95% confidence interval, 1.02-2.75; p=0.043].
Conclusions:
In nondiabetic patients with ACS with LDL-C below 1.8 mmol/L, a high TyG index level was associated with higher incidence of AMI, larger infarct size, and higher incidence of revascularization. A high TyG index level might be a valid predictor of subsequent revascularization.
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