Association between Triglyceride-Glucose Index and Major Adverse Cardiovascular Events Risk in Coronary Heart Disease Patients with Blood Stasis Syndrome after Percutaneous Coronary Intervention

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Association between Triglyceride-Glucose Index and Major Adverse Cardiovascular Events Risk in Coronary Heart Disease Patients with Blood Stasis Syndrome after Percutaneous Coronary Intervention

更新时间：2024-08-27

- Association between Triglyceride-Glucose Index and Major Adverse Cardiovascular Events Risk in Coronary Heart Disease Patients with Blood Stasis Syndrome after Percutaneous Coronary Intervention
- Journal of Traditional Chinese Medicine Vol. 65, Issue 17, Pages: 1784-1793(2024)
- 作者机构：
  
  1.北京中医药大学，北京市朝阳区北三环东路11号，100029
  2.中国中医科学院广安门医院
  3.中日友好医院
- 作者简介：
- 基金信息：
- DOI：10.13288/j.11-2166/r.2024.17.008
  CLC：
- Received：31 October 2023，
  
  Revised：2024-01-30，
  
  Published：02 September 2024
- 稿件说明：
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陶诗怡,于林童,李军等.冠心病PCI术后血瘀证患者甘油三酯葡萄糖乘积指数与主要心血管不良事件风险的相关性[J].中医杂志,2024,65(17):1784-1793.

TAO Shiyi,YU Lintong,LI Jun,et al.Association between Triglyceride-Glucose Index and Major Adverse Cardiovascular Events Risk in Coronary Heart Disease Patients with Blood Stasis Syndrome after Percutaneous Coronary Intervention[J].Journal of Traditional Chinese Medicine,2024,65(17):1784-1793.
陶诗怡,于林童,李军等.冠心病PCI术后血瘀证患者甘油三酯葡萄糖乘积指数与主要心血管不良事件风险的相关性[J].中医杂志,2024,65(17):1784-1793. DOI： 10.13288/j.11-2166/r.2024.17.008.

TAO Shiyi,YU Lintong,LI Jun,et al.Association between Triglyceride-Glucose Index and Major Adverse Cardiovascular Events Risk in Coronary Heart Disease Patients with Blood Stasis Syndrome after Percutaneous Coronary Intervention[J].Journal of Traditional Chinese Medicine,2024,65(17):1784-1793. DOI： 10.13288/j.11-2166/r.2024.17.008.

摘要

目的

2

探讨冠心病经皮冠状动脉介入术（PCI）后血瘀证患者甘油三酯葡萄糖乘积（TyG）指数与主要心血管不良事件（MACEs）风险的相关性。

方法

2

纳入冠心病PCI术后血瘀证患者857例，依据基线TyG指数四分位数分为Q1（TyG＜8.51）、Q2（8.51≤TyG＜8.88）、Q3（8.88≤TyG＜9.22）、Q4（TyG≥9.22）四组。临床结局指标为MACEs，包括心源性死亡、非致死性心肌梗死、非计划性血运重建、支架内再狭窄、脑卒中。通过机器学习Boruta算法进行MACEs风险相关特征变量选择。利用Kaplan-Meier生存分析和Cox比例风险回归模型分析比较各组间MACEs风险差异。采用限制性立方样条（RCS）和亚组分析探讨TyG指数和MACEs风险的关系。通过受试者工作特征（ROC）曲线下面积（AUC）、校准曲线、Hosmer-Lemeshow检验及决策曲线分析（DCA）评价TyG指数对MACEs风险的临床预测效能。

结果

2

纳入患者中位随访时间为2.45年，新发MACEs患者313例（36.52%）。Q1组、Q2组、Q3组、Q4组的发病率分别为28.17%（60例/213例）、29.05%（61例/210例）、39.45%（86例/218例）、49.07%（106例/216例）。Kaplan-Meier生存分析表明，各组间MACEs风险比较差异有统计学意义（

P

＜0.001）。Cox比例风险回归模型分析表明，高TyG指数的MACEs风险升高了60.1%（

P

＜0.01）。以Q1组为参照，Q2组、Q3组和Q4组的MACEs风险随着TyG指数增加逐渐升高，趋势变化具有统计学意义（

P

＜0.05）。RCS分析表明，TyG指数与MACEs风险呈非线性相关（

P

＜0.001）。ROC曲线分析［AUC 0.758（0.724～0.792）］和Hosmer-Lemeshow检验结果（

χ

2

=4.319，

P

=0.827）提示，TyG指数对MACEs风险的临床预测效能较高；DCA分析表明TyG指数有较好的临床有效性。亚组分析显示，在年龄、男性、体重指数（BMI）、糖尿病史是或否、有高血压病史、低密度脂蛋白胆固醇（LDL-C）≥1.8 mmol

/

L各亚组中，均表明高TyG指数与MACEs风险呈正相关（

P

＜0.05）。

结论

2

冠心病PCI术后血瘀证患者的高TyG指数与MACEs的发生密切相关，对患者早期风险分层和诊疗决策有一定的指导意义。

Abstract

Objective

2

To explore the association between triglyceride-glucose （TyG） index and major adverse cardiovascular events （MACEs） risk in coronary heart disease （CHD） patients with blood stasis syndrome after percutaneous coronary intervention （PCI）.

Methods

2

A total of 857 CHD patients with blood stasis syndrome after PCI were enrolled and divided into four groups according to the baseline TyG index quartiles， Q1 （TyG ＜ 8.51）， Q2 （8.51 ≤ TyG ＜ 8.88）， Q3 （8.88 ≤ TyG ＜ 9.22）， and Q4 （TyG ≥ 9.22）. The clinical outcome was defined as a compound endpoint of cardiovascular events including cardiac death， non-fatal myocardial infarction， unplanned revascularization， in-stent restenosis and stroke. The machine learning Boruta algorithm was used for feature selection related to MACEs risk. Kaplan-Meier survival analysis and Cox proportional hazards regression model were used to compare the differences in MACEs risk among the four groups. Restricted cubic spline （RCS） and subgroup analysis were performed to determine the relationship between the TyG index and MACEs risk. The area under the receiver operating characteristic （ROC） curve （AUC）， calibration curve and Hosmer-Lemeshow test， and decision curve analysis （DCA） were plotted to evaluate the predictive value of the TyG index for MACEs risk.

Results

2

The median follow-up time of the included patients was 2.45 years. During the follow-up period， 313 cases （36.52%） of new MACEs occurred. The incidence of MACEs in Q1， Q2， Q3， Q4 group was 28.17% （60/213）， 29.05% （61/210）， 39.45% （86/218） and 49.07% （106/216）， respectively. Kaplan-Meier survival analysis suggested statistically significant differences in MACEs risk among the four groups （

P

＜0.001）. Cox proportional hazards regression model analysis found that the risk of MACEs in patients with high TyG index increased by 60.1% （

P

＜0.01）. Using Q1 as the reference， the MACEs risk in Q2， Q3 and Q4 groups gradually increased， and the trend was statistically significant （

P

＜0.05）. RCS model suggested that the TyG index was nonlinearly associated with the MACEs risk （

P

＜0.001）. The TyG index had a good predictive performance for MACEs risk according to ROC analysis （AUC=0.758， 0.724-0.792） and Hosmer-Lemeshow test （

χ

2

= 4.319，

P

= 0.827）. Additionally， DCA analysis also suggested a good clinical efficacy of the TyG index for predicting MACEs. Subgroup analysis showed that different baseline TyG index was positively correlated with the MACEs risk in the stratification of age， male， BMI， history of diabetes and hypertension， and low-density lip

oprotein cholesterol （LDL-C）≥1.8 mmol

·

L

-

1

（

P

＜0.05）.

Conclusion

2

The elevated TyG index is closely corrected with an increased risk of MACEs in CHD patients with blood stasis syndrome after PCI， indicating a guiding significance for early risk stratification and clinical decisions.

关键词

Keywords

references

LAWTON JS ， TAMIS-HOLLAND JE ， BANGALORE S ， et al . 2021 ACC/AHA/SCAI guideline for coronary artery revascularization： a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines ［J］. Circulation ， 2022 ， 145 （ 3 ）： e18 - e114 .

PATHAK S ， LAI FY ， MIKSZA J ， et al . Surgical or percutaneous coronary revascularization for heart failure： an in silico model using routinely collected health data to emulate a clinical trial ［J］. Eur Heart J ， 2023 ， 44 （ 5 ）： 351 - 364 .

KNUUTI J ， WIJNS W ， SARASTE A ， et al . 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes ［J］. Eur Heart J ， 2020 ， 41 （ 3 ）： 407 - 477 .

KAHN SE ， COOPER ME ， DEL PRATO S . Pathophysio-logy and treatment of type 2 diabetes： perspectives on the past， present， and future ［J］. Lancet ， 2014 ， 383 （ 9922 ）： 1068 - 1083 .

BRITO ADM ， HERMSDORFF HHM ， FILGUEIRAS MS ， et al . Predictive capacity of triglyceride-glucose （TyG） index for insulin resistance and cardiometabolic risk in children and adolescents： a systematic review ［J］. Crit Rev Food Sci Nutr ， 2021 ， 61 （ 16 ）： 2783 - 2792 .

CHEN Q ， XIONG S ， ZHANG Z ， et al . Triglyceride-glucose index is associated with recurrent revascularization in patients with type 2 diabetes mellitus after percutaneous coronary intervention ［J］. Cardiovasc Diabetol ， 2023 ， 22 （ 1 ）： 284 .

GUO X ， SHEN R ， YAN S ， et al . Triglyceride-glucose index for predicting repeat revascularization and in-stent restenosis in patients with chronic coronary syndrome undergoing percutaneous coronary intervention ［J］. Cardiovasc Diabetol ， 2023 ， 22 （ 1 ）： 43 .

黄湘龙，李霄，杨丰文，等 . 1970—2021年冠心病中医证候特征演变规律文献研究［J］. 中医杂志， 2023 ， 64 （ 10 ）： 1058 - 1063 .

郗瑞席，陈可冀，史大卓，等 . 介入术后冠心病中医证候诊断标准的评价［J］. 中国中西医结合杂志， 2013 ， 33 （ 8 ）： 1036 - 1041 .

LUO E ， WANG D ， YAN G ， et al . High triglyceride-glucose index is associated with poor prognosis in patients with acute ST-elevation myocardial infarction after percutaneous coronary intervention ［J］. Cardiovasc Diabetol ， 2019 ， 18 （ 1 ）： 150 .

ZHU Y ， LIU K ， CHEN M ， et al . Triglyceride-glucose index is associated with in-stent restenosis in patients with acute coronary syndrome after percutaneous coronary intervention with drug-eluting stents ［J］. Cardiovasc Diabetol ， 2021 ， 20 （ 1 ）： 137 .

MA X ， DONG L ， SHAO Q ， et al . Triglyceride glucose index for predicting cardiovascular outcomes after percutaneous coronary intervention in patients with type 2 diabetes mellitus and acute coronary syndrome ［J］. Cardiovasc Diabetol ， 2020 ， 19 （ 1 ）： 31 .

万霞，刘建平 . 临床研究中的样本量估算：（2）观察性研究［J］. 中医杂志， 2007 ， 48 （ 7 ）： 599 - 601 .

GUERRERO-ROMERO F ， SIMENTAL-MENDIA LE ， GONZALEZ-ORTIZ M ， et al . The product of triglycerides and glucose， a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp ［J］. J Clin Endocrinol Metab ， 2010 ， 95 （ 7 ）： 3347 - 3351 .

HICKS KA ， TCHENG JE ， BOZKURT B ， et al . 2014 ACC/AHA key data elements and definitions for cardiovascular endpoint events in clinical trials： a report of the American College of Cardiology/American Heart Association task force on clinical data standards （writing committee to develop cardiovascular endpoints data standards）［J］. Circulation ， 2015 ， 132 （ 4 ）： 302 - 361 .

DEGENHARDT F ， SEIFERT S ， SZYMCZAK S . Evaluation of variable selection methods for random forests and omics data sets ［J］. Brief Bioinform ， 2019 ， 20 （ 2 ）： 492 - 503 .

中国心血管健康与疾病报告编写组 . 中国心血管健康与疾病报告2022概要［J］. 中国循环杂志， 2023 ， 38 （ 6 ）： 583 - 612 .

中华医学会心血管病学分会介入心脏病学组，中国医师协会心血管内科医师分会血栓防治专业委员会，中华心血管病杂志编辑委员会 . 中国经皮冠状动脉介入治疗指南（2016）［J］. 中华心血管病杂志， 2016 ， 44 （ 5 ）： 382 - 400 .

MADHAVAN MV ， KIRTANE AJ ， REDFORS B ， et al . Stent-related adverse events ＞1 year after percutaneous coronary intervention ［J］. J Am Coll Cardiol ， 2020 ， 75 （ 6 ）： 590 - 604 .

WANG C ， XIE Z ， HUANG X ， et al . Prevalence of cardiovascular disease risk factors in Chinese patients with type 2 diabetes mellitus， 2013-2018 ［J］. Curr Med Res Opin ， 2022 ， 38 （ 3 ）： 345 - 354 .

SINAIKO AR ， STEINBERGER J ， MORAN A ， et al . Relation of body mass index and insulin resistance to cardiovascular risk factors， inflammatory factors， and oxidative stress during adolescence ［J］. Circulation ， 2005 ， 111 （ 15 ）： 1985 - 1991 .

PIATTI P ， DI MARIO C ， MONTI LD ， et al . Association of insulin resistance， hyperleptinemia， and impaired nitric oxide release with in-stent restenosis in patients undergoing coronary stenting ［J］. Circulation ， 2003 ， 108 （ 17 ）： 2074 - 2081 .

DUGANI SB ， MOORTHY MV ， LI C ， et al . Association of lipid， inflammatory， and metabolic biomarkers with age at onset for incident coronary heart disease in women ［J］. JAMA Cardiol ， 2021 ， 6 （ 4 ）： 437 - 447 .

LAAKSO M ， KUUSISTO J . Insulin resistance and hyperglycaemia in cardiovascular disease development ［J］. Nat Rev Endocrinol ， 2014 ， 10 （ 5 ）： 293 - 302 .

王彦 . 血瘀与冠心病的相关性研究概况［J］. 中医杂志， 2012 ， 53 （ 19 ）： 1699 - 1702 .

KHEIFETS M ， VONS SA ， BENTAL T ， et al . Temporal trends in complex percutaneous coronary interventions ［J］. Front Cardiovasc Med ， 2022 ， 9 ： 913588 . doi： 10.3389/fcvm.2022.913588 http://dx.doi.org/10.3389/fcvm.2022.913588 .

LI N ， ZHOU J ， CHEN R ， et al . Prognostic impacts of diabetes status and lipoprotein（a） levels in patients with ST-segment elevation myocardial infarction： a prospective cohort study ［J］. Cardiovasc Diabetol ， 2023 ， 22 （ 1 ）： 151 .

TSCHARRE M ， HERMAN R ， ROHLA M ， et al . Prognostic impact of familial hypercholesterolemia on long-term outcomes in patients undergoing percutaneous coronary intervention ［J］. J Clin Lipidol ， 2019 ， 13 （ 1 ）： 115 - 122 .

SHAO QY ， MA XT ， YANG ZQ ， et al . Prognostic signifi-cance of multiple triglycerides-derived metabolic indices in patients with acute coronary syndrome ［J］. J Geriatr Cardiol ， 2022 ， 19 （ 6 ）： 456 - 468 .

SUN T ， HUANG X ， ZHANG B ， et al . Prognostic significance of the triglyceride-glucose index for patients with ischemic heart failure after percutaneous coronary intervention ［J］. Front Endocrinol （Lausanne）， 2023 ， 14 ： 1100399 . doi： 10.3389/fendo.2023.1100399 http://dx.doi.org/10.3389/fendo.2023.1100399 .

BEYHOFF N ， CAO D ， MEHRAN R ， et al . Prognostic impact of high-sensitivity C-reactive protein in patients undergoing percutaneous coronary intervention according to BMI ［J］. JACC Cardiovasc Interv ， 2020 ， 13 （ 24 ）： 2882 - 2892 .

FIRMAN D ， ARILAKSONO DG ， AMBARI AM ， et al . The obesity paradox： effect of body mass index on 2-years clinical outcome after primary percutaneous coronary intervention in Indonesia ［J］. Eur Rev Med Pharmacol Sci ， 2021 ， 25 （ 15 ）： 4973 - 4982 .

AZHARI Z ， ISMAIL MD ， ZUHDI ASM ， et al . Association between body mass index and outcomes after percutaneous coronary intervention in multiethnic South East Asian population： a retrospective analysis of the Malaysian National Cardiovascular Disease Database-Percutaneous Coronary Intervention （NCVD-PCI） registry ［J］. BMJ Open ， 2017 ， 7 （ 11 ）： e017794 .

ZHAO Q ， CHENG YJ ， XU YK ， et al . Comparison of various insulin resistance surrogates on prognostic prediction and stratification following percutaneous coronary intervention in patients with and without type 2 diabetes mellitus ［J］. Cardiovasc Diabetol ， 2021 ， 20 （ 1 ）： 190 .

LIU Y ， ZHU B ， ZHOU W ， et al . Triglyceride-glucose index as a marker of adverse cardiovascular prognosis in patients with coronary heart disease and hypertension ［J］. Cardiovasc Diabetol ， 2023 ， 22 （ 1 ）： 133 .

WEI A ， LIU J ， WANG L ， et al . Correlation of triglyceride-glucose index and dyslipidaemia with premature coronary heart diseases and multivessel disease： a cross-sectional study in Tianjin， China ［J］. BMJ Open ， 2022 ， 12 （ 9 ）： e065780 .

ZOU S ， XU Y . Association of the triglyceride-glucose index and major adverse cardiac and cerebrovascular events in female patients undergoing percutaneous coronary intervention with drug-eluting stents： a retrospective study ［J］. Diabetes Res Clin Pract ， 2021 ， 181 ： 109073 . doi： 10.1016/j.diabres.2021.109073 http://dx.doi.org/10.1016/j.diabres.2021.109073 .

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Related Author

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Hunan University of Chinese Medicine

Experimental Research Center，China Academy of Chinese Medical Sciences

Beijing Key Laboratory of Traditional Chinese Medicine Basic Research on Prevention and Treatment of Major Diseases

The fourth Clinical Medical College of Xinjiang Medical University

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