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TOPLINE: 

The triglyceride glucose index may predict adverse cardiovascular outcomes in patients with acute myocardial infarction (AMI) and well-controlled cholesterol levels after percutaneous coronary intervention (PCI).

METHODOLOGY:

• Many patients experience major adverse cardiovascular and cerebrovascular events (MACCEs) despite undergoing PCI and having well-controlled cholesterol levels.
• This prospective cohort study in China explored the link between triglyceride glucose levels and MACCEs in 599 patients (median age, 60 years; 64% men) with AMI and low-density lipoprotein cholesterol (LDL-C) ≤ 1.8 mmol/L at a 1-month follow-up after PCI.
• The patients were divided into three groups according to the triglyceride glucose index ( ≤ 8.19 [n=151]; 8.19-9.06 [n=299]; and ≥ 9.06 [n=149]). The median triglyceride glucose index was 8.56.
• Patients with a higher triglyceride glucose index had higher body mass index and diabetes mellitus, as well as higher fasting blood glucose, total cholesterol, triglyceride, and uric acid levels.
• The primary outcome was MACCEs, defined as a composite of all-cause death (except of definitive noncardiac causes), target lesion revascularization, target vessel revascularization, AMI, and ischemic stroke.

TAKEAWAY:

• During a follow-up period of 1 year, 90 MACCEs were recorded in 69 patients.
• Patients with a higher triglyceride glucose index (≥ 9.06 vs 8.19-9.06 vs ≤ 8.19) had a higher incidence of:
  • Overall MACCEs (22.1% vs 14.0% vs 9.9%; P = .010),
  • Target vessel revascularization (10.1% vs 4.7% vs 2.0%; P = .005), and
  • AMI (5.4% vs 1.7% vs 1.3%; P = .035).
• Multivariate analysis showed that triglyceride glucose index served as a significant predictor for the occurrence of MACCEs in patients with AMI and well-controlled LDL-C levels (odds ratio, 1.381; P = .021).
• The incidences of all-cause mortality, target lesion revascularization, and stroke were comparable among the three triglyceride glucose index groups.

IN PRACTICE:

"It is important to pay attention to TyG [triglyceride glucose] levels, especially in patients with well-controlled LDL-C levels. TyG could be used as a prognostic indicator as well as a factor for risk stratification," the authors wrote.

SOURCE:

Hong-Wei Zhao from the Department of Cardiology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China, led the study, which was published online on 18 January, 2024, in Frontiers Endocrinology.

LIMITATIONS:

The sample size of this study was relatively small, and patients were not grouped according to the diabetes diagnosis. All patients received atorvastatin and ezetimibe as LDL-C lowering treatment. Health-related variables that could affect the triglyceride glucose index, such as dietary habits, levels of daily physical activity, and smoking cessation, were not considered in this study. A target LDL-C of ≤ 1.4 mmol/L should have been taken into consideration in patients with AMI; however, this study was conducted before the publication of the most recent guidelines.

DISCLOSURES:

This study did not receive any financial support. The authors declared no conflicts of interest.