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Association Between C-Reactive Protein-Triglyceride Glucose Index and Adverse Cardiovascular Outcomes in Acute
Xiaoteng Ma1, Huijun Chu2, Qiuxuan Li1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China, ccmu.edu.cn.
Insights
The C-reactive protein-triglyceride glucose index (CTI) predicts major adverse cardiovascular events in high-risk patients with acute coronary syndrome and prior bypass surgery. Higher CTI scores indicate increased risk, aiding personalized prevention strategies.
Area of Science:
- Cardiovascular Medicine
- Biomarker Research
- Atherosclerosis Studies
Background:
- Patients with acute coronary syndrome (ACS) and prior coronary artery bypass grafting (CABG) are a high-risk group prone to recurrent ischemic events.
- Systemic inflammation and insulin resistance are key drivers of atherosclerosis progression and plaque instability in these patients.
- The prognostic value of the C-reactive protein-triglyceride glucose index (CTI), a novel composite biomarker, was uncertain in this population.
Purpose of the Study:
- To evaluate the prognostic impact of the C-reactive protein-triglyceride glucose index (CTI) on long-term outcomes in ACS patients with prior CABG.
- To determine if CTI improves risk stratification for major adverse cardiovascular and cerebrovascular events (MACCE).
Main Methods:
- 1195 ACS patients with prior CABG undergoing percutaneous coronary intervention (PCI) were enrolled.
- The CTI was calculated using high-sensitivity C-reactive protein, fasting triglycerides, and fasting blood glucose levels.
- Patients were stratified into tertiles based on CTI, and the primary endpoint was MACCE (all-cause death, stroke, myocardial infarction, unplanned revascularization) over 3 years.
Main Results:
- A total of 366 patients experienced MACCE over a median 3-year follow-up.
- MACCE incidence progressively increased across CTI tertiles (log-rank p < 0.001).
- The highest CTI tertile was an independent predictor of MACCE (adjusted HR: 3.864), and each unit increase in CTI raised MACCE risk by 80.1% (adjusted HR: 1.801). CTI significantly improved risk prediction models.
Conclusions:
- The CTI is a significant independent predictor of long-term MACCE in ACS patients with prior CABG undergoing PCI.
- Integrating CTI into risk stratification models can enhance prognostic assessment.
- CTI may facilitate personalized and intensive secondary prevention strategies for this high-risk cohort.
Background:
Patients with acute coronary syndrome (ACS) who have previously undergone coronary artery bypass grafting (CABG) represent a complex, high-risk population characterized by a substantial burden of atherosclerosis and a marked propensity for recurrent ischemic events. The pathophysiological interplay between systemic inflammation and insulin resistance serves as a key mediator driving the progression of atherosclerosis and the destabilization of atherosclerotic plaques. However, the prognostic impact of their combined effect, quantified by a novel composite biomarker-the C-reactive protein-triglyceride glucose index (CTI)-remains uncertain in this specific high-risk population.
Methods:
We enrolled 1195 ACS patients with prior CABG who underwent percutaneous coronary intervention (PCI). The CTI was calculated as 0.412 × ln (high-sensitivity C-reactive protein [mg/L]) + ln (fasting triglycerides [mg/dL] × fasting blood glucose [mg/dL]/2). Patients were divided into three groups based on their CTI tertiles. The primary endpoint was defined as the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE), which encompassed all-cause death, nonfatal stroke, nonfatal myocardial infarction (MI), and unplanned revascularization.
Results:
Over a median follow-up of 3 years, 366 patients experienced MACCE. The incidence of MACCE progressively increased across CTI tertiles (log-rank p < 0.001). In the multivariable Cox proportional hazards model adjusted for the GRACE (Global Registry of Acute Coronary Events) risk score and a comprehensive panel of clinical, procedural, and laboratory confounders, the highest CTI tertile remained an independent predictor of MACCE (adjusted hazard ratio [HR]: 3.864, 95% confidence interval [CI]: 2.710-5.511, p < 0.001). When CTI was analyzed as a continuous variable, each unit increase was found to confer an 80.1% greater risk of MACCE (adjusted HR: 1.801, 95% CI: 1.556-2.085, p < 0.001). This association remained consistent across all predefined subgroups. Adding CTI tertiles to the baseline model-which encompassed the GRACE risk score and other confounders-yielded a modest but statistically significant improvement in predictive performance (C-statistic increased from 0.605 to 0.655, p < 0.001; continuous net reclassification improvement [cNRI]: 0.740, p = 0.032; integrated discrimination improvement [IDI]: 0.145, p = 0.020).
Conclusions:
The CTI-a composite biomarker that captures both systemic inflammation and insulin resistance-emerged as a significant and independent predictor of long-term MACCE in ACS patients with prior CABG who underwent PCI. Its integration into risk stratification models may improve prognostic assessment and potentially facilitate more personalized and intensive secondary prevention strategies.
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