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High triglyceride-glucose index predicts cardiovascular events in patients with coronary bifurcation lesions: a
Jining He1,2,3, Sheng Yuan1,2,3, Chenxi Song1,2,3
1State Key Laboratory of Cardiovascular Disease, Beijing, China.
Insights
The triglyceride-glucose (TyG) index predicts cardiovascular events in patients with coronary artery disease (CAD) and bifurcation lesions. A high TyG index is linked to increased risk, aiding in prognosis and risk stratification.
Area of Science:
- Cardiology
- Metabolic Syndrome
- Vascular Health
Background:
- Coronary bifurcation lesions present a higher risk for poor long-term prognosis compared to non-bifurcation lesions.
- The triglyceride-glucose (TyG) index is a known predictor of cardiovascular (CV) events in coronary artery disease (CAD) patients.
- The prognostic role of the TyG index in high-risk patients with bifurcation lesions remains unclear.
Purpose of the Study:
- To investigate the association between the TyG index and CV events in patients with coronary bifurcation lesions.
- To determine if the TyG index can aid in risk stratification for this specific patient group.
Main Methods:
- A cohort of 4530 patients with angiography-proven CAD and bifurcation lesions was analyzed.
- The TyG index was calculated using fasting triglyceride and glucose levels.
- Patients were categorized into three groups based on TyG index tertiles, and cardiovascular events were tracked over 3 years using Cox proportional hazard models and restricted cubic spline analysis.
Main Results:
- An elevated TyG index (T2 and T3 tertiles) was significantly associated with an increased risk of CV events after multivariable adjustment (HR 1.68-2.10).
- The association was particularly strong in diabetic patients, with higher TyG index correlating with significantly higher CV event risk (HR 2.68).
- The TyG index demonstrated consistent associations across various subgroups and improved the predictive performance of existing risk models.
Conclusions:
- A high TyG index is significantly associated with adverse cardiovascular outcomes in patients with coronary bifurcation lesions.
- The TyG index serves as a valuable tool for risk stratification and prognosis assessment in this high-risk population.
- Further research may explore therapeutic strategies targeting TyG index improvement in patients with bifurcation lesions.
Background:
Coronary bifurcation lesion, as a complex coronary lesion, is associated with higher risk of long-term poor prognosis than non-bifurcation lesions. The triglyceride-glucose (TyG) index has been shown to predict cardiovascular (CV) events in patients with coronary artery disease (CAD). However, the prognostic value of the TyG index in patients with bifurcation lesions who are at high risk of CV events remains undetermined. Therefore, this study aimed to investigate the association between the TyG index and CV events in patients with bifurcation lesions.
Methods:
A total of 4530 consecutive patients with angiography-proven CAD and bifurcation lesions were included in this study from January 2017 to December 2018. The TyG index was calculated as Ln [fasting triglyceride (mg/dL) × fasting plasma glucose (mg/dL)/2]. Patients were assigned into 3 groups according to TyG tertiles (T) (T1: <8.633; T2: 8.633-9.096 and T3: ≥9.096). The primary endpoint was CV events, including CV death, nonfatal myocardial infarction and nonfatal stroke at 3-year follow-up. Restricted cubic spline (RCS) analysis, Kaplan-Meier curves and Cox proportional hazard models were used to investigate the associations between the TyG index and study endpoints.
Results:
During a median follow-up of 3.1 years, 141 (3.1%) CV events occurred. RCS analysis demonstrated a linear relationship between the TyG index and events after adjusting for age and male sex (non-linear P = 0.262). After multivariable adjustments, elevated TyG index (both T2 and T3) was significantly associated with the risk of CV events (hazard ratio [HR], 1.68; 95% confidence interval [CI],1.06-2.65; HR, 2.10; 95%CI, 1.28-3.47, respectively). When study patients were further stratified according to glycemic status, higher TyG index was associated with significantly higher risk of CV events in diabetic patients after adjusting for confounding factors (T3 vs. T1; HR, 2.68; 95%CI, 1.17-6.11). In addition, subgroup analysis revealed consistent associations of the TyG index with 3-year CV events across various subgroups. Furthermore, adding the TyG index to the original model significantly improved the predictive performance.
Conclusions:
High TyG index was associated with CV events in patients with bifurcation lesions, suggesting the TyG index could help in risk stratification and prognosis in this population.
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