Triglyceride-Glucose Index: a novel prognostic predictor for postoperative cerebral infarction in off-pump coronary artery bypass grafting - insights from a nationwide multicentre study.
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Abstract
Background: Postoperative cerebral infarction following coronary artery bypass grafting (CABG) for multivessel coronary artery disease (CAD) is a major complication and is associated with insulin resistance (IR). This study used the Triglyceride-Glucose (TyG) Index, a robust indicator of IR, to assess its association with cerebral infarction and other adverse events in patients with off-pump CABG (OPCABG).
Methods: This retrospective observational study included 3654 CAD cases from eight centres across China. The primary outcome was postoperative cerebral infarction. The predictive role of the TyG Index was evaluated using multivariate logistic regression and restricted cubic spline regression. Receiver operating characteristics analysis was conducted to assess its impact on model performance.
Results: A total of 89 patients experienced postoperative cerebral infarction. After adjusting for confounding factors, the TyG Index, whether treated as a categorical variable (OR=2.23, 95% CI 1.24 to 4.02) or a continuous variable (OR=1.80, 95% CI 1.29 to 2.51), was found to be a significant independent risk factor for postoperative cerebral infarction (both p<0.001). The restricted cubic splines regression model revealed a linear dose-response association between the TyG Index and the risk of postoperative cerebral infarction (p for non-linearity=0.861). Subgroup analysis did not indicate any interactions among subgroups (p for interaction >0.05). Incorporating the TyG Index yielded a modest but statistically significant improvement in discrimination for postoperative cerebral infarction (area under the receiver operating characteristics curve 0.724 vs 0.708; p<0.001).
Conclusions: IR reflected by an elevated TyG Index predicts the risk of postoperative cerebral infarction in patients undergoing OPCABG.
Trial registration number: Chinese Clinical Trial Registry: Chictr2400085741.
背景：多支冠状动脉疾病（CAD）冠状动脉旁路移植术（CABG）术后脑梗死是一个主要并发症，并与胰岛素抵抗（IR）相关。本研究使用甘油三酯-葡萄糖（TyG）指数（IR的一个强有力的指标）来评估其与脑梗死和其他不良事件在非体外循环CABG （OPCABG）患者中的关联。方法：本回顾性观察研究包括来自中国8个中心的3654例CAD病例。主要结局为术后脑梗死。采用多元逻辑回归和限制三次样条回归对TyG指数的预测作用进行评价。进行了接收机工作特性分析，以评估其对模型性能的影响。结果：89例患者术后发生脑梗死。在校正混杂因素后，无论是作为分类变量（OR=2.23, 95% CI 1.24 ~ 4.02）还是作为连续变量（OR=1.80, 95% CI 1.29 ~ 2.51）， TyG指数都是术后脑梗死的重要独立危险因素（均p0.05）。纳入TyG指数对术后脑梗死的判别有一定的改善（受者工作特征曲线下面积0.724 vs 0.708），但有统计学意义。结论：TyG指数升高反映的IR可预测OPCABG患者术后脑梗死的风险。试验注册号：中国临床试验注册中心：Chictr2400085741。
期刊介绍：
Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.
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