High triglyceride-glucose index is associated with poor prognosis in patients with acute ST-elevation myocardial infarction after percutaneous coronary intervention
High triglyceride-glucose index is associated with poor prognosis in patients with acute ST-elevation myocardial infarction after percutaneous coronary intervention
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高甘油三酯-葡萄糖指数与经皮冠状动脉介入治疗后急性ST段抬高型心肌梗死患者预后不良相关
DOI：
10.1186/s12933-019-0957-3
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发表时间：
2019-11-13
影响因子：
9.3
通讯作者：
Tang, Chengchun
中科院分区：
文献类型：
--
作者：
Luo, Erfei;Wang, Dong;Tang, Chengchun
背景胰岛素抵抗（IR）被认为是心血管代谢疾病的重要危险因素，而胰岛素-葡萄糖指数（TyG指数）已成为IR的可靠替代指标。尽管最近的一些研究表明TyG指数与血管疾病相关，但尚未有研究进一步探讨TyG指数在急性ST段抬高型心肌梗死（STEMI）中的作用。本研究的目的是评价TyG指数作为经皮冠状动脉介入治疗（PCI）后STEMI患者预后预测因子的潜在作用。方法对1092例STEMI患者行PCI治疗。根据TyG指数水平将患者分为4个四分位数。记录随访期间的临床特征、空腹血糖（FPG）、甘油三酯（TG）、其他生化指标以及主要不良心血管和脑事件（MACCE）的发生率。使用以下公式计算TyG指数：ln[空腹TG（mg/dL）x FPG（mg/dL）/2]。结果TyG指数处于最高四分位数的STEMI患者，PCI术后30 d、6个月和1年内MACCE发生率和全因死亡率较高。TyG指数与STEMI患者PCI后1年内MACCE风险增加显著相关，独立于混杂因素，最高四分位数的TyG指数为1.529（95%CI 1.001-2.061; P = 0.003）。预测STEMI患者PCI术后发生MACCE的TyG指数曲线下面积（AUC）为0.685（95%CI 0.610-0.761; P = 0.001）。Killip分级> 1级、贫血、白蛋白、尿酸、支架数量和左室射血分数（LVEF）是STEMI患者PCI术后发生MACCE的独立预测因素（均P < 0.05）。结论本研究首次提示STEMI患者中TyG指数升高与MACCE风险增加相关，TyG指数可能是STEMI患者PCI术后临床结局的有效预测因子。试验注册ChiCTR 1900024577。
Background Insulin resistance (IR) is considered a pivotal risk factor for cardiometabolic diseases, and the triglyceride-glucose index (TyG index) has emerged as a reliable surrogate marker of IR. Although several recent studies have shown the association of the TyG index with vascular disease, no studies have further investigated the role of the TyG index in acute ST-elevation myocardial infarction (STEMI). The objective of the present study was to evaluate the potential role of the TyG index as a predictor of prognosis in STEMI patients after percutaneous coronary intervention (PCI). Methods The study included 1092 STEMI patients who underwent PCI. The patients were divided into 4 quartiles according to TyG index levels. Clinical characteristics, fasting plasma glucose (FPG), triglycerides (TGs), other biochemical parameters, and the incidence of major adverse cardiovascular and cerebral events (MACCEs) during the follow-up period were recorded. The TyG index was calculated using the following formula: ln[fasting TGs (mg/dL) x FPG (mg/dL)/2]. Results The incidence of MACCEs and all-cause mortality within 30 days, 6 months and 1 year after PCI were higher among STEMI patients with TyG index levels in the highest quartile. The TyG index was significantly associated with an increased risk of MACCEs in STEMI patients within 1 year after PCI, independent of confounding factors, with a value of 1.529 (95% CI 1.001-2.061; P = 0.003) for those in the highest quartile. The area under the curve (AUC) of the TyG index predicting the occurrence of MACCEs in STEMI patients after PCI was 0.685 (95% CI 0.610-0.761; P = 0.001). The results also revealed that Killip class > 1, anaemia, albumin, uric acid, number of stents and left ventricular ejection fraction (LVEF) were independent predictors of MACCEs in STEMI patients after PCI (all P < 0.05). Conclusions This study indicated an association between higher TyG index levels and increased risk of MACCEs in STEMI patients for the first time, and the TyG index might be a valid predictor of clinical outcomes in STEMI patients undergoing PCI. Trial Registration ChiCTR1900024577.