Yi Kan, Xiaoteng Ma, Zehao Zhao, Shutong Dong, Yinxiao Xu, Yan Sun, Yujing Cheng, Dai Zhang, Yuyang Liu, Xiaoli Liu, Dongmei Shi, Yujie Zhou
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引用次数: 0
Abstract
Background: The prognostic value of triglyceride-glucose (TyG) has been well described in patients with coronary artery disease (CAD). Hyperhomocysteinemia (HHcy) promotes insulin resistance and has also been regarded as a potential risk factor for cardiovascular disease. However, the prognostic value of TyG in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) and the interaction between TyG and HHcy remain unclear.
Methods: A total of 1,734 ACS patients undergoing PCI were continuously enrolled between June 2016 and November 2017 at Beijing Anzhen Hospital. Patients were categorized into four groups based on HHcy status and the optimal cut-off value of TyG. The primary endpoint was major adverse cardiovascular events (MACE), a composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and unplanned repeat revascularization.
Results: Over a median follow-up of 927 days, 358 patients (20.6%) experienced MACE. The Kaplan-Meier curves showed significant differences in the cumulative incidence of MACE among prespecified groups (p < 0.001). Multivariable Cox regression analysis revealed that higher TyG was significantly associated with an increased risk of MACE in patients without HHcy (HR: 2.36, 95% CI: 1.53-3.64, p < 0.001), but not in patients with HHcy (HR: 1.31, 95% CI: 0.60-2.87, p = 0.503). Restricted cubic splines only demonstrated the prognostic value of TyG in patients without HHcy. A significant interaction was observed for MACE between TyG and HHcy (p for interaction = 0.01).
Conclusions: The prognostic value of TyG was modified by HHcy in ACS patients undergoing PCI. Higher TyG was only associated with an increased risk of MACE in ACS patients without HHcy, but not in ACS patients with HHcy.
背景：甘油三酯-葡萄糖（TyG）在冠状动脉疾病（CAD）患者中的预后价值已被很好地描述。高同型半胱氨酸血症（HHcy）促进胰岛素抵抗，也被认为是心血管疾病的潜在危险因素。然而，TyG在急性冠脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）中的预后价值以及TyG与HHcy的相互作用尚不清楚。方法：2016年6月至2017年11月在北京安贞医院连续入组1734例接受PCI治疗的ACS患者。根据HHcy状态和TyG的最佳临界值将患者分为四组。主要终点是主要心血管不良事件（MACE），包括全因死亡、非致死性心肌梗死、非致死性卒中和计划外重复血运重建术。结果：在中位927天的随访中，358例患者（20.6%）经历了MACE。Kaplan-Meier曲线显示，预先设定的组间MACE累积发生率有显著差异（p p p = 0.503）。限制三次样条仅显示TyG在无HHcy患者中的预后价值。TyG与HHcy对MACE有显著交互作用（交互作用p = 0.01）。结论：TyG在ACS行PCI患者中的预后价值被HHcy所改变。较高的TyG仅与无HHcy的ACS患者MACE风险增加相关，而与有HHcy的ACS患者无关。
期刊介绍：
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