PDF(Pubmed)
Abstract：
BACKGROUND: The metabolic score for insulin resistance (METS-IR) is a simple, convenient, and reliable marker for resistance insulin (IR), which has been regarded as a predictor of cardiovascular disease (CVD) and cardiovascular events. However, few studies examined the relationship between METS-IR and prognosis after coronary artery bypass graft (CABG). This study aimed to investigate the potential value of METS-IR as a prognostic indicator for the major adverse cardiovascular events (MACE) in patients after CABG.
METHODS: 1100 CABG patients were enrolled in the study, including 760 men (69.1%) and 340 women (30.9%). The METS-IR was calculated as Ln [(2 × FPG (mg/dL) + fasting TG (mg/dL)] × BMI (kg/m2)/Ln [HDL-C (mg/dL)]. The primary endpoint of this study was the occurrence of major adverse cardiovascular events (MACE), including a composite of all-cause death, non-fatal myocardial infarction (MI), coronary artery revascularization, and stroke.
RESULTS: The following-up time of this study was 49-101 months (median, 70 months; interquartile range, 62-78 months). During the follow-up period, there were 243 MACEs (22.1%). The probability of cumulative incidence of MACE increased incrementally across the quartiles of METS-IR (log-rank test, p < 0.001). Multivariate Cox regression analysis demonstrated a hazard ratio (95% CI) of 1.97 (1.36-2.86) for MACE in quartile 4 compared with participants in quartile 1. The addition of the METS-IR to the model with fully adjusting variables significantly improved its predictive value [C-statistic increased from 0.702 to 0.720, p < 0.001, continuous net reclassification improvement (NRI) = 0.305, < 0.001, integrated discrimination improvement (IDI) = 0.021, p < 0.001].
CONCLUSIONS: METS-IR is an independent and favorable risk factor for predicting the occurrence of MACE and can be used as a simple and reliable indicator that can be used for risk stratification and early intervention in patients after CABG.
METHODS: 1100 CABG patients were enrolled in the study, including 760 men (69.1%) and 340 women (30.9%). The METS-IR was calculated as Ln [(2 × FPG (mg/dL) + fasting TG (mg/dL)] × BMI (kg/m2)/Ln [HDL-C (mg/dL)]. The primary endpoint of this study was the occurrence of major adverse cardiovascular events (MACE), including a composite of all-cause death, non-fatal myocardial infarction (MI), coronary artery revascularization, and stroke.
RESULTS: The following-up time of this study was 49-101 months (median, 70 months; interquartile range, 62-78 months). During the follow-up period, there were 243 MACEs (22.1%). The probability of cumulative incidence of MACE increased incrementally across the quartiles of METS-IR (log-rank test, p < 0.001). Multivariate Cox regression analysis demonstrated a hazard ratio (95% CI) of 1.97 (1.36-2.86) for MACE in quartile 4 compared with participants in quartile 1. The addition of the METS-IR to the model with fully adjusting variables significantly improved its predictive value [C-statistic increased from 0.702 to 0.720, p < 0.001, continuous net reclassification improvement (NRI) = 0.305, < 0.001, integrated discrimination improvement (IDI) = 0.021, p < 0.001].
CONCLUSIONS: METS-IR is an independent and favorable risk factor for predicting the occurrence of MACE and can be used as a simple and reliable indicator that can be used for risk stratification and early intervention in patients after CABG.
摘要：
背景：胰岛素抵抗的代谢评分（METS-IR）是一个简单的，方便,和可靠的胰岛素抵抗（IR）标志物，被认为是心血管疾病（CVD）和心血管事件的预测因子。然而,很少有研究探讨METS-IR与冠状动脉旁路移植术(CABG)后预后的关系.本研究旨在探讨METS-IR作为CABG术后主要不良心血管事件(MACE)预后指标的潜在价值。
方法：1100例CABG患者被纳入研究，包括760名男性(69.1%)和340名女性(30.9%)。METS-IR计算为Ln[(2×FPG(mg/dL)+空腹TG(mg/dL)]×BMI(kg/m2)/Ln[HDL-C(mg/dL)]。这项研究的主要终点是主要不良心血管事件（MACE）的发生，包括全因死亡，非致死性心肌梗死(MI),冠状动脉血运重建,和中风。
结果：本研究的随访时间为49-101个月（中位数，70个月；四分位数范围，62-78个月）。在后续期间,有243个MACEs（22.1%）。MACE累积发生率的概率在METS-IR的四分位数中递增(对数秩检验，p<0.001)。多变量Cox回归分析显示，与四分位数1的参与者相比，四分位数4的MACE的风险比（95％CI）为1.97（1.36-2.86）。在完全调整变量的模型中添加METS-IR显著改善了其预测值[C统计量从0.702增加到0.720,p<0.001,连续净重新分类改善(NRI)=0.305,<0.001,综合辨别改善(IDI)=0.021,p<0.001]。
结论：METS-IR是预测MACE发生的独立且有利的危险因素，可作为一个简单可靠的指标，用于CABG术后患者的危险分层和早期干预。
方法：1100例CABG患者被纳入研究，包括760名男性(69.1%)和340名女性(30.9%)。METS-IR计算为Ln[(2×FPG(mg/dL)+空腹TG(mg/dL)]×BMI(kg/m2)/Ln[HDL-C(mg/dL)]。这项研究的主要终点是主要不良心血管事件（MACE）的发生，包括全因死亡，非致死性心肌梗死(MI),冠状动脉血运重建,和中风。
结果：本研究的随访时间为49-101个月（中位数，70个月；四分位数范围，62-78个月）。在后续期间,有243个MACEs（22.1%）。MACE累积发生率的概率在METS-IR的四分位数中递增(对数秩检验，p<0.001)。多变量Cox回归分析显示，与四分位数1的参与者相比，四分位数4的MACE的风险比（95％CI）为1.97（1.36-2.86）。在完全调整变量的模型中添加METS-IR显著改善了其预测值[C统计量从0.702增加到0.720,p<0.001,连续净重新分类改善(NRI)=0.305,<0.001,综合辨别改善(IDI)=0.021,p<0.001]。
结论：METS-IR是预测MACE发生的独立且有利的危险因素，可作为一个简单可靠的指标，用于CABG术后患者的危险分层和早期干预。
