背景:多支血管冠状动脉疾病(MVCD)是急性冠状动脉综合征(ACS)中常见的冠状动脉疾病类型。冠状动脉钙化(CAC)已被证实是主要不良心血管事件(MACE)的强预测因子。一些研究已经验证了甘油三酯葡萄糖(TyG)指数可以反映冠状动脉钙化程度或预测MACE。然而,迄今为止,尚无证据阐明和比较TyG指数或/和冠状动脉钙化评分(CACS)对ACS患者多血管疾病和MACE的预测强度.
方法:共935例患者,2015年8月至2022年3月在山东大学第二医院诊断为ACS,并经历了冠状动脉CT血管造影(CCTA),进行回顾性分析。将受试者分为TyG指数四分位数1-4组(Q1-Q4组),非多支血管冠状动脉疾病(非MVCD)和多支血管冠状动脉疾病(MVCD)组,分别。一般数据,既往病史或用药史,实验室指标,心脏彩色多普勒超声,CACS,分别比较各组的TyG指数。ROC曲线初步计算并分析了TyG指数的诊断价值,CACS,以及MVCD两个指标的组合。单因素和多因素Logistic回归分析区分了预测MVCD的独立危险因素。
结果:与较低的TyG指数和非MVCD组相比,较高的TyG指数和MVCD组有较高的年龄值,吸烟史,腰围,收缩压,低密度脂蛋白胆固醇(LDL-C),空腹血糖和糖化血红蛋白,和CACS,但高密度脂蛋白胆固醇(HDL-C)值较低(均P<0.01)。冠状动脉钙化多见于左前降支。与非MVCD相比,TyG指数每增加1个单位与MVCD风险增加1.213倍相关.对潜在混杂因素进行校正的Logistic回归分析显示,TyG指数是MVCD的独立危险因素。随着TyG指数的增加,MACE的发生率,除了全因死亡,心脏死亡,意外的心力衰竭再次住院,复发性ACS或计划外血运重建,冠状动脉非致死性卒中增加(Plog-rank<0.001)。
结论:TyG指数可以完全替代CACS,实用,预测ACS患者MVCD严重程度和预后的独立指标。
BACKGROUND: Multivessel coronary disease (MVCD) is the common type of coronary artery disease in acute coronary syndrome (ACS). Coronary artery calcification (CAC) has been confirmed the strong predictor of major adverse cardiovascular events (MACEs). Several studies have validated that triglyceride glucose (TyG) index can reflect the degree of coronary calcification or predict MACEs. However, no evidence to date has elucidated and compared the predictive intensity of TyG index or/and coronary artery calcification score (CACS) on multi-vascular disease and MACEs in ACS patients.
METHODS: A total of 935 patients, diagnosed with ACS and experienced coronary computed tomography angiography (CCTA) from August 2015 to March 2022 in the Second Hospital of Shandong University, were selected for retrospective analysis. The subjects were divided into TyG index quartile 1-4 groups (Q1-Q4 groups), non-multivessel coronary disease (non-MVCD) and multivessel coronary disease (MVCD) groups, respectively. The general data, past medical or medication history, laboratory indicators, cardiac color Doppler ultrasound, CACS, and TyG indexes were respectively compared among these groups. The ROC curve preliminarily calculated and analyzed the diagnostic value of TyG index, CACS, and the combination of the two indicators for MVCD. Univariate and multivariate logistic regression analysis discriminated the independent hazard factors for forecasting MVCD.
RESULTS: Compared with the lower TyG index and non-MVCD groups, the higher TyG index and MVCD groups had higher values of age, smoking history, waist circumference, systolic blood pressure, low-density lipoprotein cholesterol(LDL-C), fasting blood glucose and glycosylated hemoglobin, and CACS, but lower values of high-density lipoprotein cholesterol(HDL-C) (all P < 0.01). Coronary artery calcification is more common in the left anterior descending artery. Compared with non-MVCD, each unit increase in TyG index was associated with a 1.213-fold increased risk of MVCD. Logistic regression analysis adjusted for potential confounders indicated that TyG index is an independent risk factor for MVCD. With the increase of TyG index, the incidence of MACEs, apart from all-cause death, cardiac death, unexpected re-hospitalization of heart failure, recurrent ACS or unplanned revascularization, and non-fatal stroke in coronary artery increased (P log-rank < 0.001).
CONCLUSIONS: TyG index could completely substitute for CACS as a reliable, practical, and independent indicator for predicting the severity and prognosis of MVCD in patients with ACS.