Insulin resistance, coronary artery lesion complexity and adverse cardiovascular outcomes in patients with acute coronary syndrome.

Publisher: BioMed Central Country of Publication: England NLM ID: 101147637 Publication Model: Electronic Cited Medium: Internet ISSN: 1475-2840 (Electronic) Linking ISSN: 14752840 NLM ISO Abbreviation: Cardiovasc Diabetol Subsets: MEDLINE

Original Publication: London : BioMed Central, [2002-

Acute Coronary Syndrome*/blood ; Acute Coronary Syndrome*/mortality ; Acute Coronary Syndrome*/therapy ; Acute Coronary Syndrome*/diagnosis ; Acute Coronary Syndrome*/epidemiology ; Insulin Resistance* ; Percutaneous Coronary Intervention*/adverse effects ; Percutaneous Coronary Intervention*/mortality ; Blood Glucose*/metabolism ; Biomarkers*/blood ; Coronary Artery Disease*/blood ; Coronary Artery Disease*/therapy ; Coronary Artery Disease*/mortality ; Coronary Artery Disease*/diagnostic imaging ; Coronary Artery Disease*/diagnosis; Humans ; Male ; Female ; Middle Aged ; Aged ; Risk Assessment ; Risk Factors ; Treatment Outcome ; Time Factors ; Triglycerides/blood ; Retrospective Studies ; Predictive Value of Tests

Background: Insulin resistance (IR) is linked to both the complexity of coronary artery lesions and the prognosis of acute coronary syndrome (ACS). However, the precise extent of this correlation and its impact on adverse cardiovascular outcomes in ACS patients remain unclear. Therefore, this study aims to investigate the intricate relationship between IR, coronary artery lesion complexity, and the prognosis of ACS through a cohort design analysis.
Method: A total of 986 patients with ACS who underwent percutaneous coronary intervention (PCI) were included in this analysis. IR was assessed using the triglyceride-glucose (TyG) index, while coronary artery lesion complexity was evaluated using the SYNTAX score. Pearson's correlation coefficients were utilized to analyze the correlations between variables. The association of the TyG index and SYNTAX score with major adverse cardiovascular events (MACEs) in ACS was investigated using the Kaplan-Meier method, restricted cubic splines (RCS), and adjusted Cox regression. Additionally, a novel 2-stage regression method for survival data was employed in mediation analysis to explore the mediating impact of the SYNTAX score on the association between the TyG index and adverse cardiovascular outcomes, including MACEs and unplanned revascularization.
Results: During a median follow-up of 30.72 months, 167 cases of MACEs were documented, including 66 all-cause deaths (6.69%), 26 nonfatal myocardial infarctions (MIs) (2.64%), and 99 unplanned revascularizations (10.04%). The incidence of MACEs, all-cause death, and unplanned revascularization increased with elevated TyG index and SYNTAX score. Both the TyG index (non-linear, P = 0.119) and SYNTAX score (non-linear, P = 0.004) displayed a positive dose-response relationship with MACEs, as illustrated by the RCS curve. Following adjustment for multiple factors, both the TyG index and SYNTAX score emerged as significant predictors of MACEs across the total population and various subgroups. Mediation analysis indicated that the SYNTAX score mediated 25.03%, 18.00%, 14.93%, and 11.53% of the correlation between the TyG index and MACEs in different adjusted models, respectively. Similar mediating effects were observed when endpoint was defined as unplanned revascularization.
Conclusion: Elevated baseline TyG index and SYNTAX score were associated with a higher risk of MACEs in ACS. Furthermore, the SYNTAX score partially mediated the relationship between the TyG index and adverse cardiovascular outcomes.
(© 2024. The Author(s).)

Circ Res. 2018 May 11;122(10):1439-1459. (PMID: 29748368)
EuroIntervention. 2009 May;5(1):50-6. (PMID: 19577983)
J Am Coll Cardiol. 2000 Jul;36(1):219-26. (PMID: 10898438)
JAMA. 2004 Apr 21;291(15):1857-63. (PMID: 15100204)
J Hypertens. 2023 Dec 1;41(12):1874-2071. (PMID: 37345492)
J Am Coll Cardiol. 2017 Jan 31;69(4):395-403. (PMID: 28126156)
Circ Res. 2007 Jun 8;100(11):1546-55. (PMID: 17556668)
Cardiovasc Diabetol. 2024 Feb 24;23(1):79. (PMID: 38402392)
BMJ. 2021 Jan 13;372:m4573. (PMID: 33441402)
Biomedicines. 2021 Jul 28;9(8):. (PMID: 34440108)
Intern Emerg Med. 2021 Nov;16(8):2069-2076. (PMID: 34304351)
Cardiovasc Diabetol. 2021 Jun 24;20(1):126. (PMID: 34167539)
Cardiovasc Diabetol. 2023 Jan 6;22(1):2. (PMID: 36609319)
J Am Coll Cardiol. 2022 Nov 1;80(18):1735-1747. (PMID: 36302586)
Diabetes Care. 2023 Nov 1;46(11):2050-2057. (PMID: 37713581)
Cardiovasc Diabetol. 2019 Mar 4;18(1):24. (PMID: 30832662)
Cardiovasc Diabetol. 2022 Sep 1;21(1):168. (PMID: 36050734)
Cardiovasc Diabetol. 2021 Jul 8;20(1):137. (PMID: 34238294)
Cardiovasc Diabetol. 2022 Jul 1;21(1):124. (PMID: 35778731)
J Am Coll Cardiol. 2023 Dec 19;82(25):2350-2473. (PMID: 38092509)
Ageing Res Rev. 2017 Nov;40:31-44. (PMID: 28802803)
Cardiovasc Diabetol. 2023 Oct 21;22(1):284. (PMID: 37865753)
Diabetes Care. 2019 Aug;42(8):1569-1573. (PMID: 31182490)
Cardiovasc Diabetol. 2023 Jul 6;22(1):170. (PMID: 37415168)
Nat Rev Cardiol. 2021 Apr;18(4):251-275. (PMID: 33037326)
Metabolism. 2021 Jun;119:154770. (PMID: 33864798)
Epidemiology. 2011 Jul;22(4):582-5. (PMID: 21642779)
J Am Coll Cardiol. 2021 Sep 21;78(12):1227-1238. (PMID: 34531023)
Diabetes Care. 2023 Jan 1;46(Suppl 1):S19-S40. (PMID: 36507649)
Eur Heart J. 2021 Apr 7;42(14):1289-1367. (PMID: 32860058)
Cardiovasc Diabetol. 2020 Mar 16;19(1):34. (PMID: 32178666)
Cardiovasc Diabetol. 2023 Dec 19;22(1):350. (PMID: 38115031)
Nutr Metab Cardiovasc Dis. 2020 Nov 27;30(12):2351-2362. (PMID: 32917496)
Cardiovasc Diabetol. 2018 Aug 31;17(1):122. (PMID: 30170598)
Cardiovasc Diabetol. 2023 Mar 12;22(1):56. (PMID: 36907849)
Med Clin North Am. 2004 Jul;88(4):787-835, ix. (PMID: 15308380)
Eur Heart J. 2023 Oct 12;44(38):3720-3826. (PMID: 37622654)
Cardiovasc Diabetol. 2023 Nov 28;22(1):325. (PMID: 38017519)
Lancet Diabetes Endocrinol. 2021 Oct;9(10):653-662. (PMID: 34425083)
Nat Rev Endocrinol. 2014 May;10(5):293-302. (PMID: 24663222)
J Clin Endocrinol Metab. 2010 Jul;95(7):3347-51. (PMID: 20484475)

2022-NHLHCRF-YSPY-01 National High Level Hospital Clinical Research Funding; No. CSCF2021B02 Chinese Society of Cardiology's Foundation

Keywords: Acute coronary syndrome; Insulin resistance; Mediation; SYNTAX score; The triglyceride-glucose index

Date Created: 20240516 Date Completed: 20240517 Latest Revision: 20240614

20240614

PMC11100181

10.1186/s12933-024-02276-1

38755609