Title : Triglyceride-glucose index is associated with poor prognosis in patients with stable coronary artery disease undergoing coronary artery bypass grafting
Abstract:
Background: The triglyceride-glucose (TyG) index, which is a reliable substitute indicator for insulin resistance, has been considered an independent risk factor for long-term outcomes in patients with cardiovascular disease. However, at present, only a limited number of studies with small sample sizes have evaluated whether the Triglyceride-glucose (TyG) index is associated with an increased risk of poor prognosis in patients with stable coronary artery disease undergoing coronary artery bypass grafting.
Purpose: This study aimed to investigate the impact of TyG index on clinical outcomes following CABG in patients with stable coronary artery disease.
Methods: A total of 16863 participants from a registry-based cohort were enrolled and divided into groups according to the tertiles of the TyG index.The TyG index was calculated by ln[fasting triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2]. The primary outcome was the major adverse cardiovascular and cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction, cerebrovascular accidents or repeat revascularization. The associations between the TyG index and the primary endpoint was assessed by multivariable Cox proportional hazards regression analysis and restricted cubic splines.
Results: During a median follow-up of 3.3 years, 527 patients (31.3%) experienced at least one endpoint event. Based on the optimal cut-off value of the TyG index, patients were divided into the high TyG index group and the low TyG index group. After adequately adjusting for confounding factors, High TyG index group was associated with increased risk of MACCE (adjusted hazard ration [aHR]: 1.189, 95% confidence interval[95% CI]: 1.021-1.311, P?0.018), which was in line with the results observed when the TyG index was treated as a continuous variable (aHR, 1.177 [95% CI, 1.019–1.286]; P=0.02). Restricted cubic spline curve exhibited that the relationship between the TyG index and MACCE was linear (p for non-linear = 0.425, p for overall = 0.01).
Conclusion: The TyG index is independently associated with MACCE, suggesting that the TyG index may serve as a valid indicator for predicting poor prognosis in patients with stable coronary artery disease undergoing coronary artery bypass grafting.
Audience Take Away
- The present study is the first and also a large-scale analysis that focuses primarily on the association of liver fibrosis severity, as measured by the Fibrosis-4 index, and prognosis in patients who underwent coronary artery bypass grafting with prediabetes and diabetes.
- We found that high Fibrosis-4 index is common in patients undergoing coronary artery bypass grafting with prediabetes or diabetes, and is associated with poor prognosis.
- The preoperative assessment of liver fibrosis severity and liver function represents a critical risk factor for patients with prediabetes or diabetes undergoing coronary artery bypass graft surgery and should not be neglected.
