This prospective cohort study consecutively included 2740 angina patients with CTO from January 2017 to December 2018 at Fuwai Hospital. The outcomes are a composite of CV death and target vessel myocardial infarction (TVMI) and major CV cerebrovascular adverse events (MACCEs, including all-cause death, nonfatal MI, ischaemia-driven target vessel revascularization, and stroke). The association between biomarkers and prognosis was analysed by multivariable Cox proportional hazard models, and the predictive value was determined by a receiver-operating characteristic (ROC) curve.
During the follow-up with a median time of 3 years, 179 (6.5%) cases of MACCEs and 47 (1.7%) cases of CV death or TVMI were recorded. Patients with a high TyG index (> 9.10) and a high SHR (> 0.87) showed a significantly increased risk of CV death/TVMI (TyG index: HR 4.23, 95% CI 1.58-11.37; SHR: HR 5.14, 95% CI 1.89-13.98) and MACCEs (TyG index: HR 2.47, 95% CI 1.54-3.97; SHR: HR 2.91, 95% CI 1.84-4.60) compared with those with a low Tyg index and a low SHR (TyG < 8.56, SHR < 0.76). The area under the curve (AUC) values were 0.623 (TyG index) and 0.589 (SHR) for CV death/TVMI and 0.659 (TyG index) and 0.624 (SHR) for MACCEs. Furthermore, patients with both a high TyG index and a high SHR showed the highest risk of clinical outcomes among patients with different levels of these two biomarkers, and the AUC for the TyG-SHR combination was larger than the TyG index alone in predicting MACCE risk.
The study revealed that a high TyG index and a high SHR were significantly correlated with poor prognosis in patients with CTO and suggested that these two biomarkers are reliable in predicting long-term prognosis in CTO patients.
方法:这项前瞻性队列研究连续纳入2017年1月至2018年12月在阜外医院接受CTO治疗的2740例心绞痛患者。结果是心血管死亡和靶血管心肌梗死(TVMI)和主要心血管脑血管不良事件(MACCEs,包括全因死亡,非致死性MI,缺血驱动的靶血管血运重建,和中风)。通过多变量Cox比例风险模型分析生物标志物与预后之间的关系,预测值由受试者工作特征(ROC)曲线确定。
结果:在中位时间为3年的随访期间,记录了179例(6.5%)MACCE和47例(1.7%)CV死亡或TVMI。具有高TyG指数(>9.10)和高SHR(>0.87)的患者显示出CV死亡/TVMI(TyG指数:HR4.23,95%CI1.58-11.37;SHR:HR5.14,95%CI1.89-13.98)和MACCE(TyG指数:HR2.47,95%CI1.54-3.97;SHR:0.91,95%