The Prognostic Value of the Triglyceride-Glucose and Fibrosis-4 Indices in Patients Undergoing Coronary Angiography: A Retrospective Cohort Analysis

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-04-01 DOI:10.1016/j.cjco.2025.01.005

Amir Aker MD , Tom Tarchitzky BsC , Yuval Avidan MD , Barak Zafrir MD

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Abstract

Background

The triglyceride-glucose (TYG) index, which reflects insulin resistance, and the fibrosis-4 (FIB-4) index, a measure of liver fibrosis, are noninvasive laboratory-based indicators associated with cardiometabolic risk.

Methods

We performed a retrospective analysis of 12,165 patients who underwent coronary angiography, to investigate the association of the TYG and FIB-4 indices with the occurrence of myocardial infarction, stroke, or all-cause death (major cardiovascular events [MACE]), using multivariate Cox proportional hazards models.

Results

The mean age of the study population was 65 ± 10 years; 63% presented with acute coronary syndrome. During a median follow-up period of 6.1 years, the first MACE occurred in 4174 patients. Compared to the TYG index ≤ 50th percentile (≤ 8.81), the multivariable adjusted hazard ratio (95% confidence interval) for MACE was 1.17 (1.10-1.45), 1.32 (1.23-1.43), and 1.72 (1.55-1.99) for TYG index levels ≥ 50th (> 8.81), ≥ 75th (> 9.23), and ≥ 90th (9.66) percentiles, respectively. FIB-4 index levels of 1.3-2.67 and > 2.67 were associated with an adjusted hazard ratio of 1.19 (1.11-1.27) and 1.67 (1.51-1.87), respectively, compared to FIB-4 index levels of < 1.3. Regarding the risk of developing MACE, no significant interaction was detected between TYG or FIB-4 index levels and the presence of diabetes or obesity. In a combined model of both predictive measures, a gradual increase in the incidence rate of MACE was observed, ranging from 3.93 (TYG index ≤ 8.81; FIB-4 index < 1.3) to 8.56 (TYG index > 9.23; FIB-4 index > 2.67) events per 100 patient-years.

Conclusions

The TYG and FIB-4 indices, both individually and when concomitantly elevated, were independently associated with an increased risk of developing MACE in patients undergoing coronary angiography. ,. These simple-to-calculate, noninvasive metabolic biomarkers may aid in the prediction of cardiovascular diseases.

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甘油三酯-葡萄糖和纤维化-4指数在冠状动脉造影患者中的预后价值：回顾性队列分析

反映胰岛素抵抗的甘油三酯-葡萄糖（TYG）指数和衡量肝纤维化的纤维化-4 （FIB-4）指数是与心脏代谢风险相关的无创实验室指标。方法采用多变量Cox比例风险模型，对12165例接受冠状动脉造影的患者进行回顾性分析，探讨TYG和FIB-4指数与心肌梗死、卒中或全因死亡（主要心血管事件[MACE]）发生的关系。结果研究人群平均年龄为65±10岁；63%表现为急性冠脉综合征。在6.1年的中位随访期间，4174名患者发生了首次MACE。与TYG指数≤第50百分位（≤8.81）相比，TYG指数≥50 (>；8.81),≥75 (>；9.23)和≥90个百分位数（9.66）。FIB-4指数水平为1.3-2.67；与FIB-4指数<水平相比，2.67的校正风险比分别为1.19（1.11-1.27）和1.67 (1.51-1.87)；1.3. 至于发生MACE的风险，TYG或FIB-4指数水平与糖尿病或肥胖之间没有发现显著的相互作用。在两种预测指标的联合模型中，观察到MACE的发生率逐渐增加，范围从3.93 (TYG指数≤8.81；FIB-4指数1.3) ~ 8.56 (TYG指数>；9.23;FIB-4索引2.67)每100例患者年。结论TYG和FIB-4指数单独或同时升高与冠状动脉造影患者发生MACE的风险增加独立相关。，. 这些简单计算、无创的代谢生物标志物可能有助于预测心血管疾病。

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