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Published on: January 28, 2020
Association of the TyG index and inflammatory burden index with AMR-defined coronary microvascular dysfunction and
Yang Yang1, Leilei Liu1, Xiuyu Liang1
1Department of Cardiology, The Third Affiliated Hospital of Anhui Medical University (The First People's Hospital of Hefei), Hefei, Anhui, China.
Insights
Metabolic dysfunction (triglyceride-glucose index) and inflammation (inflammatory burden index) predict coronary microvascular dysfunction and adverse events after myocardial infarction. Combining these markers improves risk prediction beyond conventional factors.
Area of Science:
- Cardiology
- Biomarkers
- Vascular Biology
Background:
- Metabolic dysfunction and inflammation are implicated in coronary microvascular injury post-STEMI.
- The triglyceride-glucose (TyG) index and inflammatory burden index (IBI) may jointly impact outcomes.
- Investigating their role in coronary microvascular dysfunction (CMD) and major adverse cardiovascular events (MACE) is crucial.
Purpose of the Study:
- To assess the independent and combined associations of TyG index and IBI with CMD.
- To evaluate the incremental predictive value of TyG index and IBI beyond conventional factors for CMD.
- To determine the association of TyG index and IBI with 12-month MACE after STEMI.
Main Methods:
- Retrospective cohort study of 318 STEMI patients undergoing PPCI.
- Coronary microvascular dysfunction (CMD) defined by angiographic microvascular resistance (AMR).
- Multivariable models and sequential analysis with bootstrap validation used to assess associations with CMD and MACE.
Main Results:
- CMD present in 32.1% of patients.
- TyG index and IBI were independently associated with CMD and 12-month MACE.
- The combined TyG-IBI model significantly improved prediction of CMD when added to clinical factors (AUC increased from 0.904 to 0.939).
- Elevated TyG index and IBI identified patients at highest MACE risk.
Conclusions:
- TyG index and IBI are independent predictors of CMD and MACE after STEMI.
- Incorporating TyG index and IBI enhances risk stratification models for CMD.
- Further prospective multicenter validation is needed for clinical application.
Background:
Metabolic dysfunction and inflammation may jointly contribute to coronary microvascular injury and adverse outcomes after primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI). We examined the independent and combined associations of the triglyceride-glucose (TyG) index and inflammatory burden index (IBI) with angiographic microvascular resistance (AMR)-defined coronary microvascular dysfunction (CMD), their incremental value beyond conventional factors, and their associations with 12-month major adverse cardiovascular events (MACE).
Methods:
In this retrospective cohort study conducted at a single center, 318 STEMI patients who underwent PPCI and achieved a TIMI grade 3 flow post-procedure were enrolled. AMR was derived from the final post-PPCI angiogram of the culprit vessel, and CMD was defined as AMR >26.6 mmHg·s/dm. Multivariable models assessed associations with CMD and MACE. Sequential models evaluated the incremental performance of TyG and IBI with 1,000-resample bootstrap internal validation.
Results:
CMD was present in 102/318 (32.1%). TyG (OR per 1-unit, 3.83; 95% CI, 2.04-7.21; P<0.001) and IBI (OR per 10-units, 1.13; 95% CI, 1.07-1.20; P<0.001) were independently associated with CMD. The TyG-IBI model showed an AUC of 0.773 for CMD; adding both to a clinical/procedural model improved the AUC from 0.904 to 0.939 (bootstrap-validated, 0.920; ΔAUC, 0.036; P = 0.001). Over 12 months, 69 (21.7%) patients had MACE. TyG (HR, 1.97; 95% CI, 1.30-2.98; P = 0.001) and IBI (HR per 10-units, 1.02; 95% CI, 1.00-1.05; P = 0.022) remained independent predictors of MACE, with the highest risk in those with both markers elevated.
Conclusion:
TyG and IBI were independently associated with AMR-defined CMD and 12-month MACE after STEMI. Adding TyG and IBI to conventional clinical and procedural factors improved model discrimination for CMD, although prospective multicenter validation is required before clinical application.
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