An elevated triglyceride-glucose index predicts adverse outcomes and interacts with the treatment strategy in patients with three-vessel disease

• Published in: Cardiovascular diabetology 2023-12, Vol.22 (1), p.333-333, Article 333
• Main Authors: Zhang, Yu, Zhang, Ce, Jiang, Lin, Xu, Lianjun, Tian, Jian, Zhao, Xueyan, Wang, Dong, Zhang, Yin, Sun, Kai, Zhang, Channa, Xu, Bo, Zhao, Wei, Hui, Rutai, Gao, Runlin, Wang, Jizheng, Feng, Xinxing, Yuan, Jinqing, Song, Lei
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome; Acute coronary syndromes; Angina; Angina pectoris; Angina, Stable; Biomarkers; Blood Glucose; Body mass index; Bypass; Cardiovascular disease; Cardiovascular diseases; Coronary artery; Coronary vessels; Decision making; Diabetes; Diabetes Mellitus; Disease resistance; Family medical history; Glucose; Heart attacks; Heart surgery; Homeostasis; Humans; Hypertension; Insulin Resistance; Kidney diseases; Medical prognosis; Patients; Percutaneous Coronary Intervention - adverse effects; Revascularisation strategy; Risk Assessment; Risk Factors; Statistical analysis; Three-vessel disease; Triglyceride-glucose index; Triglycerides; Vascular Diseases; Vein & artery diseases
• ISSN: 1475-2840; 1475-2840
• DOI: 10.1186/s12933-023-02063-4

Insulin resistance is a pivotal risk factor for cardiovascular diseases, and the triglyceride-glucose (TyG) index is a well-established surrogate of insulin resistance. This study aimed to investigate the prognostic value of the TyG index and its ability in therapy guidance in patients with three-vessel disease (TVD). A total of 8862 patients with TVD with available baseline TyG index data were included in the study. The endpoint was major adverse cardiac events (MACE). All patients received coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or medical therapy (MT) alone reasonably. An elevated TyG index was defined as the TyG index greater than 9.51. During a median follow-up of 7.5 years, an elevated TyG index was significantly associated with an increased risk of MACE (adjusted hazard ratio 1.161, 95% confidence interval 1.026-1.314, p = 0.018). The elevated TyG index was shown to have a more pronounced predictive value for MACE in patients with diabetes, but failed to predict MACE among those without diabetes, whether they presented with stable angina pectoris (SAP) or acute coronary syndrome (ACS). Meanwhile, the association between an elevated TyG index and MACE was also found in patients with left main involvement. Notably, CABG conferred a significant survival advantage over PCI in patients with a normal TyG index, but was not observed to be superior to PCI in patients with an elevated TyG index unless the patients had both ACS and diabetes. In addition, the benefit was shown to be similar between MT and revascularisation among patients with SAP and an elevated TyG index. The TyG index is a potential indicator for risk stratification and therapeutic decision-making in patients with TVD.