Table_1_High triglyceride–glucose index is associated with poor cardiovascular outcomes in Chinese acute coronary syndrome patients without diabetes mellitus who underwent emergency percutaneous coronary intervention with drug-eluting stents.docx

BackgroundPrevious research has supported the association between the triglyceride–glucose index (TyG index) and the incidence and prognosis of cardiovascular disease. However, the association between the TyG index and the prognosis of patients with acute coronary syndrome (ACS) without diabetes mellitus (DM) who underwent emergency percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) has not been thoroughly investigated, and these patients may easily be neglected. Therefore, this study aimed to investigate the association between the TyG index and major adverse cardiovascular and cerebrovascular events (MACCEs) in Chinese ACS patients without DM who underwent emergency PCI with DES.
MethodsThe total number of ACS patients without DM who underwent emergency PCI with DES for this study was 1650. Ln [fasting triglycerides (mg/dL) ×fasting plasma glucose (mg/dL)/2] is the formula used to calculate the TyG index. According to the TyG index, we classified the patients into two groups. The frequency of the following endpoint events was calculated and compared between the two groups: all-cause death, non-fatal myocardial infarction (MI), non-fatal ischemia stroke, ischemia-driven revascularization and cardiac rehospitalization.
ResultsAfter a median of 47 months of follow-up [47 (40, 54)], 437 (26.5%) endpoint events were recorded in total. The TyG index was further demonstrated to be independent of MACCE by multivariable Cox regression analysis (hazard ratio [HR], 1.493; 95% confidence interval [CI], 1.230–1.812; p<0.001). The TyG index≥7.08 group had a considerably greater incidence of MACCE (30.3% vs. 22.7% in the TyG index<7.08 group, p<0.001), cardiac death (4.0% vs. 2.3% in the TyG index<7.08 group, p=0.047), and ischemia-driven revascularization (5.7% vs. 3.6% in the TyG index<7.08 group, p=0.046) than the TyG index<7.08 group. Between the two groups, there was no discernible difference in all-cause death (5.6% vs. 3.8% in the TyG index<7.08 group, p=0.080), non-fatal MI (1.0% vs. 0.2% in the TyG index<7.08 group, p=0.057), non-fatal ischemic stroke (1.6% vs. 1.0% in the TyG index<7.08 group, p=0.272), and cardiac rehospitalization (16.5% vs. 14.1% in the TyG index<7.08 group, p=0.171).
ConclusionFor ACS patients without DM who received emergency PCI with DES, the TyG index might be an independent predictor of MACCE.

【背景】既往研究已证实甘油三酯-葡萄糖指数（triglyceride–glucose index, TyG指数）与心血管疾病的发生及预后存在关联。然而，针对未合并糖尿病（diabetes mellitus, DM）、接受药物洗脱支架（drug-eluting stents, DESs）急诊经皮冠状动脉介入治疗（percutaneous coronary intervention, PCI）的急性冠状动脉综合征（acute coronary syndrome, ACS）患者，其TyG指数与预后的关联尚未得到充分研究，且该类人群往往容易被忽视。因此，本研究旨在探讨接受急诊PCI置入DES的无DM中国ACS患者中，TyG指数与主要不良心脑血管事件（major adverse cardiovascular and cerebrovascular events, MACCEs）的关联。

【方法】本研究共纳入1650例接受急诊PCI置入DES的无DM ACS患者。TyG指数的计算公式为：Ln[空腹甘油三酯（mg/dL）×空腹血浆葡萄糖（mg/dL）/2]。依据TyG指数将患者分为两组，计算并比较两组的以下终点事件发生率：全因死亡、非致死性心肌梗死（myocardial infarction, MI）、非致死性缺血性脑卒中、缺血驱动的血运重建以及心脏再住院。

【结果】中位随访47个月[四分位间距40~54个月]后，共记录到437例（26.5%）终点事件。多变量Cox回归分析显示，TyG指数是MACCE的独立预测因素（风险比[hazard ratio, HR]=1.493；95%置信区间[confidence interval, CI]=1.230~1.812；P<0.001）。TyG指数≥7.08组的MACCE发生率（30.3% vs. TyG指数<7.08组的22.7%，P<0.001）、心源性死亡发生率（4.0% vs. 2.3%，P=0.047）以及缺血驱动血运重建发生率（5.7% vs. 3.6%，P=0.046）均显著高于TyG指数<7.08组。两组在全因死亡（5.6% vs. 3.8%，P=0.080）、非致死性MI（1.0% vs. 0.2%，P=0.057）、非致死性缺血性脑卒中（1.6% vs. 1.0%，P=0.272）以及心脏再住院率（16.5% vs. 14.1%，P=0.171）方面均无显著差异。

【结论】对于接受急诊PCI置入DES的无DM ACS患者，TyG指数或可作为MACCE的独立预测因素。