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Journal of Geriatric Cardiology 2023, 20(3): 185-194 https://doi.org/10.26599/1671-5411.2023.03.001
Research Article | Open Access | Issue | Published: 03 April 2023

Triglyceride glucose index predicts in-hospital mortality in patients with ST-segment elevation myocardial infarction who underwent primary angiography

Show Author's Information Rui FU1,*,  Yan-Yan ZHAO2,*,  Kong-Yong CUI1,  Jin-Gang YANG3,  Hai-Yan XU3,  Dong YIN1,  Wei-Hua SONG1,  Hong-Jian WANG1,  Cheng-Gang ZHU1,  Lei FENG1,  Zhi-Fang WANG4,  Qing-Sheng WANG5,  Ye LU2,  Ke-Fei DOU1( ),  Yue-Jin YANG3( )
Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Medical Research & Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Department of Cardiology, Xinxiang Central Hospital, the Fourth Clinical College of Xinxiang Medical University, Henan Province, China
Department of Cardiology, Qinhuangdao First Hospital, Hebei Province, China

*The authors contributed equally to this manuscript

Cite this article:
FU R, ZHAO Y-Y, CUI K-Y, et al. Triglyceride glucose index predicts in-hospital mortality in patients with ST-segment elevation myocardial infarction who underwent primary angiography. Journal of Geriatric Cardiology, 2023, 20(3): 185-194. https://doi.org/10.26599/1671-5411.2023.03.001
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Abstract Full text Electronic supplementary material About this article
OBJECTIVES

To assess the correlation between triglyceride glucose (TyG) index and in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI).

METHODS

A total of 2190 patients with STEMI who underwent primary angiography within 12 h from symptom onset were selected from the prospective, nationwide, multicenter CAMI registry. TyG index was calculated with the formula: Ln [fasting triglycerides (mmol/L) × fasting glucose (mmol/L)/2]. Patients were divided into three groups according to the tertiles of TyG index. The primary endpoint was in-hospital mortality.

RESULTS

Overall, 46 patients died during hospitalization, in-hospital mortality was 1.5%, 2.2%, 2.6% for tertile 1, tertile 2, and tertile 3, respectively. However, TyG index was not significantly correlated with in-hospital mortality in single-variable logistic regression analysis. Nonetheless, after adjusting for age and sex, TyG index was significantly associated with higher mortality when regarded as a continuous variable (adjusted OR = 1.75, 95% CI: 1.16-2.63) or categorical variable (tertile 3 vs. tertile 1: adjusted OR = 2.50, 95% CI: 1.14-5.49). Furthermore, TyG index, either as a continuous variable (adjusted OR = 2.54, 95% CI: 1.42-4.54) or categorical variable (tertile 3 vs. tertile 1: adjusted OR = 3.57, 95% CI: 1.24-10.29), was an independent predictor of in-hospital mortality after adjusting for multiple confounders in multivariable logistic regression analysis. In subgroup analysis, the prognostic effect of high TyG index was more significant in patients with body mass index < 18.5 kg/m2 (Pinteraction = 0.006).

CONCLUSIONS

This study showed that TyG index was positively correlated with in-hospital mortality in STEMI patients who underwent primary angiography, especially in underweight patients.


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Abstract
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Electronic supplementary material
About this article

Triglyceride glucose index predicts in-hospital mortality in patients with ST-segment elevation myocardial infarction who underwent primary angiography

Show Author's information Rui FU1,*, Yan-Yan ZHAO2,*, Kong-Yong CUI1, Jin-Gang YANG3, Hai-Yan XU3, Dong YIN1, Wei-Hua SONG1, Hong-Jian WANG1, Cheng-Gang ZHU1, Lei FENG1, Zhi-Fang WANG4, Qing-Sheng WANG5, Ye LU2, Ke-Fei DOU1( ), Yue-Jin YANG3( )
Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Medical Research & Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Department of Cardiology, Xinxiang Central Hospital, the Fourth Clinical College of Xinxiang Medical University, Henan Province, China
Department of Cardiology, Qinhuangdao First Hospital, Hebei Province, China

*The authors contributed equally to this manuscript

Abstract

OBJECTIVES

To assess the correlation between triglyceride glucose (TyG) index and in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI).

METHODS

A total of 2190 patients with STEMI who underwent primary angiography within 12 h from symptom onset were selected from the prospective, nationwide, multicenter CAMI registry. TyG index was calculated with the formula: Ln [fasting triglycerides (mmol/L) × fasting glucose (mmol/L)/2]. Patients were divided into three groups according to the tertiles of TyG index. The primary endpoint was in-hospital mortality.

RESULTS

Overall, 46 patients died during hospitalization, in-hospital mortality was 1.5%, 2.2%, 2.6% for tertile 1, tertile 2, and tertile 3, respectively. However, TyG index was not significantly correlated with in-hospital mortality in single-variable logistic regression analysis. Nonetheless, after adjusting for age and sex, TyG index was significantly associated with higher mortality when regarded as a continuous variable (adjusted OR = 1.75, 95% CI: 1.16-2.63) or categorical variable (tertile 3 vs. tertile 1: adjusted OR = 2.50, 95% CI: 1.14-5.49). Furthermore, TyG index, either as a continuous variable (adjusted OR = 2.54, 95% CI: 1.42-4.54) or categorical variable (tertile 3 vs. tertile 1: adjusted OR = 3.57, 95% CI: 1.24-10.29), was an independent predictor of in-hospital mortality after adjusting for multiple confounders in multivariable logistic regression analysis. In subgroup analysis, the prognostic effect of high TyG index was more significant in patients with body mass index < 18.5 kg/m2 (Pinteraction = 0.006).

CONCLUSIONS

This study showed that TyG index was positively correlated with in-hospital mortality in STEMI patients who underwent primary angiography, especially in underweight patients.

References(36)

[1]

Odegaard JI, Chawla A. Pleiotropic actions of insulin resistance and inflammation in metabolic homeostasis. Science 2013; 339: 172−177.
DOI Google Scholar
[2]
Laakso M. Is insulin resistance a feature of or a primary risk factor for cardiovascular disease? Curr Diab Rep 2015; 15: 105.
DOI
[3]

Kurtul BE, Kurtul A, Yalcin F. Predictive value of the SYNTAX score for diabetic retinopathy in stable coronary artery disease patients with a concomitant type 2 diabetes mellitus. Diabetes Res Clin Pract 2021; 177: 108875.
DOI Google Scholar
[4]

Guerrero-Romero F, Simental-Mendia LE, Gonzalez-Ortiz M, et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab 2010; 95: 3347−3351.
DOI Google Scholar
[5]

Vasques AC, Novaes FS, de Oliveira Mda S, et al. TyG index performs better than HOMA in a Brazilian population: a hyperglycemic clamp validated study. Diabetes Res Clin Pract 2011; 93: e98−e100.
DOI Google Scholar
[6]

Irace C, Carallo C, Scavelli FB, et al. Markers of insulin resistance and carotid atherosclerosis. A comparison of the homeostasis model assessment and triglyceride glucose index. Int J Clin Pract 2013; 67: 665−672.
DOI Google Scholar
[7]

Xie Y, Guo R, Li Z, et al. Temporal relationship between body mass index and triglyceride-glucose index and its impact on the incident of hypertension. Nutr Metab Cardiovasc Dis 2019; 29: 1220−1229.
DOI Google Scholar
[8]

Xuan X, Hamaguchi M, Cao Q, et al. U-shaped association between the triglyceride-glucose index and the risk of incident diabetes in people with normal glycemic level: A population-base longitudinal cohort study. Clin Nutr 2021; 40: 1555−1561.
DOI Google Scholar
[9]

Guo W, Zhu W, Wu J, et al. Triglyceride glucose index is associated with arterial stiffness and 10-year cardiovascular disease risk in a chinese population. Front Cardiovasc Med 2021; 8: 585776.
DOI Google Scholar
[10]

Won KB, Lee BK, Park HB, et al. Quantitative assessment of coronary plaque volume change related to triglyceride glucose index: The Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) registry. Cardiovasc Diabetol 2020; 19: 113.
DOI Google Scholar
[11]

Won KB, Park EJ, Han D, et al. Triglyceride glucose index is an independent predictor for the progression of coronary artery calcification in the absence of heavy coronary artery calcification at baseline. Cardiovasc Diabetol 2020; 19: 34.
DOI Google Scholar
[12]

Ding X, Wang X, Wu J, et al. Triglyceride-glucose index and the incidence of atherosclerotic cardiovascular diseases: a meta-analysis of cohort studies. Cardiovasc Diabetol 2021; 20: 76.
DOI Google Scholar
[13]

Mao Q, Zhou D, Li Y, et al. The triglyceride-glucose index predicts coronary artery disease severity and cardiovascular outcomes in patients with non-ST-segment elevation acute coronary syndrome. Dis Markers 2019; 2019: 6891537.
DOI Google Scholar
[14]

Wang L, Cong HL, Zhang JX, et al. Triglyceride-glucose index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome. Cardiovasc Diabetol 2020; 19: 80.
DOI Google Scholar
[15]

Zhang Y, Ding X, Hua B, et al. High triglyceride-glucose index is associated with adverse cardiovascular outcomes in patients with acute myocardial infarction. Nutr Metab Cardiovasc Dis 2020; 30: 2351−2362.
DOI Google Scholar
[16]

Luo E, Wang D, Yan G, et al. High triglyceride-glucose index is associated with poor prognosis in patients with acute ST-elevation myocardial infarction after percutaneous coronary intervention. Cardiovasc Diabetol 2019; 18: 150.
DOI Google Scholar
[17]

Luo JW, Duan WH, Yu YQ, et al. Prognostic significance of triglyceride-glucose index for adverse cardiovascular events in patients with coronary artery disease: a systematic review and meta-analysis. Front Cardiovasc Med 2021; 8: 774781.
DOI Google Scholar
[18]

Jiao Y, Su Y, Shen J, et al. Evaluation of the long-term prognostic ability of triglyceride-glucose index for elderly acute coronary syndrome patients: a cohort study. Cardiovasc Diabetol 2022; 21: 3.
DOI Google Scholar
[19]
Xu H, Li W, Yang J, et al. The China Acute Myocardial Infarction (CAMI) Registry: A national long-term registry-research-education integrated platform for exploring acute myocardial infarction in China. Am Heart J 2016; 175: 193-201 e3.
DOI
[20]

Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Eur Heart J 2012; 33: 2551−2567.
DOI Google Scholar
[21]

American Diabetes A. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2018. Diabetes Care 2018; 41: S13−S27.
DOI Google Scholar
[22]

Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39: 3021−3104.
DOI Google Scholar
[23]

Rabar S, Harker M, O'Flynn N, et al. Lipid modification and cardiovascular risk assessment for the primary and secondary prevention of cardiovascular disease: summary of updated NICE guidance. BMJ 2014; 349: g4356.
DOI Google Scholar
[24]

Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2005; 67: 2089−2100.
DOI Google Scholar
[25]

Simental-Mendia LE, Rodriguez-Moran M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord 2008; 6: 299−304.
DOI Google Scholar
[26]

Scherrer U, Sartori C. Insulin as a vascular and sympathoexcitatory hormone: implications for blood pressure regulation, insulin sensitivity, and cardiovascular morbidity. Circulation 1997; 96: 4104−4113.
DOI Google Scholar
[27]

Paolillo S, Rengo G, Pellegrino T, et al. Insulin resistance is associated with impaired cardiac sympathetic innervation in patients with heart failure. Eur Heart J Cardiovasc Imaging 2015; 16: 1148−1153.
DOI Google Scholar
[28]

Das DK, Engelman RM, Rousou JA, Breyer RH. Aerobic vs anaerobic metabolism during ischemia in heart muscle. Ann Chir Gynaecol 1987; 76: 68−76.
Google Scholar
[29]
Stanley WC. Myocardial energy metabolism during ischemia and the mechanisms of metabolic therapies. J Cardiovasc Pharmacol Ther 2004; 9 Suppl 1: S31-S45.
DOI
[30]

Aroor AR, Mandavia CH, Sowers JR. Insulin resistance and heart failure: molecular mechanisms. Heart Fail Clin 2012; 8: 609−617.
DOI Google Scholar
[31]

Cooper SA, Whaley-Connell A, Habibi J, et al. Renin-angiotensin-aldosterone system and oxidative stress in cardiovascular insulin resistance. Am J Physiol Heart Circ Physiol 2007; 293: H2009−H2023.
DOI Google Scholar
[32]

Underwood PC, Adler GK. The renin angiotensin aldosterone system and insulin resistance in humans. Curr Hypertens Rep 2013; 15: 59−70.
DOI Google Scholar
[33]

Creager MA, Luscher TF, Cosentino F, Beckman JA. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: Part I. Circulation 2003; 108: 1527−1532.
DOI Google Scholar
[34]

Trifunovic D, Stankovic S, Sobic-Saranovic D, et al. Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function. Cardiovasc Diabetol 2014; 13: 73.
DOI Google Scholar
[35]

Song C, Fu R, Yang J, et al. The association between body mass index and in-hospital outcome among patients with acute myocardial infarction-insights from China Acute Myocardial Infarction (CAMI) registry. Nutr Metab Cardiovasc Dis 2019; 29: 808−814.
DOI Google Scholar
[36]

Kalantar-Zadeh K, Block G, Horwich T, Fonarow GC. Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure. J Am Coll Cardiol 2004; 43: 1439−1444.
DOI Google Scholar
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Published: 03 April 2023
Issue date: March 2023

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ACKNOWLEDGEMENTS

This work was supported by CAMS Innovation Fund for Medical Sciences (CIFMS: 2021-I2M-1-008), Beijing Municipal Health Commission-Capital Health Development Research Project (2020-1-4032), Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (CIFMS: 2020-I2M-C&T-B-056), and the Twelfth Five-Year Planning Project of the Scientific and Technological Department of China (2011BAI11B02). All authors had no conflicts of interest to disclose.

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