Discordance between the triglyceride glucose index and fasting plasma glucose or HbA1C in patients with acute coronary syndrome undergoing percutaneous coronary intervention predicts cardiovascular events: a cohort study from China
Discordance between the triglyceride glucose index and fasting plasma glucose or HbA1C in patients with acute coronary syndrome undergoing percutaneous coronary intervention predicts cardiovascular events: a cohort study from China
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DOI：
10.1186/s12933-020-01091-8
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发表时间：
2020-07-23
影响因子：
9.3
通讯作者：
Zhao, Yingxin
中科院分区：
文献类型：
--
作者：
Hu, Chengping;Zhang, Jianwei;Zhao, Yingxin
背景以往的研究已经调查了甘油三酯葡萄糖（TyG）指数与心血管事件发生率的关系。然而，迄今为止，还没有研究比较空腹血糖（FPG）、糖化血红蛋白A（HbA 1C）和TyG指数对心血管事件风险的预测价值。本研究旨在使用不一致性分析来评价和比较FPG、HbA 1C和TyG指数预测心血管事件风险的有效性。方法选择经皮冠状动脉介入治疗（PCI）的急性冠脉疾病（ACS）患者。使用以下公式计算TyG指数：ln [空腹甘油三酯（mg/dL）x FPG（mg/dL）/2]。我们将患者分为4个一致性/不一致性组。不一致性定义为TyG指数等于或大于中位数，FPG或HbA 1C小于中位数，反之亦然。主要结局是死亡、非致死性心肌梗死、非致死性卒中和计划外重复血运重建的复合终点。采用考克斯比例风险回归模型，根据一致性/不一致性组估计心血管事件的风险。对分为HbA 1C或FPG高或低类别的每个患者组进行敏感性分析，并根据糖尿病状态重复分析。结果共有9285例患者纳入最终统计分析（男性：75.3%，年龄：59.9 ± 10.05岁，BMI：26.2 ± 9.21 kg/m2，糖尿病：43.9%，血脂异常：76.8%）。FPG、HbA 1C和TyG指数的一致性/不一致性中位数分别为6.19 mmol/L、6.1%和8.92 mmol/L。TyG指数与甘油三酯和HDL-C密切相关（r分别为0.881和-0.323，P均< 0.001）。在17.4 +/- 2.69个月的随访期间，发生了480例（5.1%）心血管事件。在HbA 1C或FPG较低的患者中，分别有15.6%和16.3%的患者在完全校正后具有不一致的高TyG指数，与一致的低TyG指数的患者相比，心血管事件的风险更高（HR：1.92，95% CI 1.33-2.77; HR：1.89，95% CI 1.38-2.59; HbA 1C和FPG分别）。使用FPG或HbA 1C和糖尿病状态的高或低类别进行重复风险估计证实了结果。结论：无论糖尿病状态如何，TyG指数异常高的患者发生心血管事件的风险显著增加。对于接受PCI的ACS患者，TyG指数可能是比FPG或HbA 1C更好的心血管风险预测因子。这种不一致性可能支持更好的心血管风险管理，无论糖尿病状态如何。
Background Previous studies have investigated the relationship of the triglyceride glucose (TyG) index with the incidence of cardiovascular events. However, to date, there have been no studies comparing the predictive values of fasting plasma glucose (FPG), glycosylated hemoglobin A (HbA1C) and the TyG index for the risk of cardiovascular events. This study aimed to use discordance analysis to evaluate and compare the effectiveness of FPG, HbA1C and the TyG index to predict the risk of cardiovascular events. Methods Patients diagnosed with acute coronary disease (ACS) undergoing percutaneous coronary intervention (PCI) were enrolled in this study. The TyG index was computed using the following formula: ln [fasting triglycerides (mg/dL) x FPG (mg/dL)/2]. We categorized patients into 4 concordance/discordance groups. Discordance was defined as a TyG index equal to or greater than the median and an FPG or HbA1C less than the median, or vice versa. The primary outcome was the composite of death, nonfatal myocardial infarction, nonfatal stroke and unplanned repeat revascularization. A Cox proportional hazards regression model was performed to estimate the risk of cardiovascular events according to the concordance/discordance groups. Sensitivity analysis was performed on each patient group divided into high or low categories for HbA1C or FPG and were repeated according to diabetes status. Results In total, 9285 patients were included in the final statistical analysis (male: 75.3%, age: 59.9 +/- 10.05 years, BMI: 26.2 +/- 9.21 kg/m(2), diabetes: 43.9% and dyslipidemia: 76.8%). The medians defining concordance/discordance were 6.19 mmol/L for FPG, 6.1% for HbA1C and 8.92 for the TyG index. The TyG index was strongly related to triglycerides and HDL-C (r = 0.881 and -0.323, respectively; both P < 0.001). During the 17.4 +/- 2.69 months of follow-up, there were 480 (5.1%) incident cardiovascular events. Among patients with a lower HbA1C or FPG, 15.6% and 16.3%, respectively, had a discordantly high TyG index and a greater risk of cardiovascular events compared with patients with a concordantly low TyG index after full adjustment (HR: 1.92, 95% CI 1.33-2.77; HR: 1.89, 95% CI 1.38-2.59; for HbA1C and FPG, respectively). Repeat risk estimation using high or low categories for FPG or HbA1C and diabetes status confirmed the results. Conclusions Patients with a discordantly high TyG index had a significantly greater risk of cardiovascular events regardless of diabetes status. The TyG index might be a better predictor of cardiovascular risk than FPG or HbA1C for patients with ACS undergoing PCI. This discordance may support better cardiovascular risk management regardless of diabetes status.