Association between triglyceride glucose index, coronary artery calcification and multivessel coronary disease in Chinese patients with acute coronary syndrome

Abstract

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).

Conclusion: 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.

Trial registration: ClinicalTrials.gov NCT04026724.

Keywords: Acute coronary syndrome; Coronary artery calcification score; Coronary computed tomography angiography; Multivessel disease; Triglyceride glucose product index.

Conflict of interest statement

We declare that we have no conflict of interest..

© 2022. The Author(s).

Figures

Fig. 1

CTA images of a 75 year old woman with severe coronary calcification and disease. Different coronary CTA three-dimensional reconstruction techniques were used: A–D, VRT (volume rendering technique) for the whole myocardium and coronary arteries. E–H, VRT for coronary vascular trees. I–M, MIP (maximum intensity projections) for coronary vascular trees. N–U, CPR (curved planner reconstruction) for the degree of coronary stenosis and calcification in each large coronary branch: right coronary artery (N and R); left anterior descending branch (O and S); left circumflex branch (P and T); left marginal branch (Q); first diagonal branch (U)

Fig. 2

Comparison of coronary calcification scores in each quartile array of TyG index. vs. TyG index quartile 1 group. *P < 0.05, **P < 0.01; vs. TyG index quartile 2 group, #P < 0.05, ##P < 0.01; vs. TyG index quartile 3 group, ∆P < 0.05, ∆∆P < 0.01

Fig. 3

Forest plot demonstrated clinical risk factors significantly affecting coronary calcification. The association between clinical risk factors and coronary calcification degree was displayed in the forest plot. OR, Odd Ratio; CI: confidence interval, all P < 0.05%. Adjusted for age, gender, AHD (antihypertensive drugs), HGD (Hypoglycemic drugs), LLD (lipid-lowering drugs), body weight, BMI(body mass index), WC (waist circumference), SBP (systolic blood pressure), DBP (diastolic blood pressure), PPD(pulse pressure difference), HR (heart rate), FBG (fasting blood glucose), HbA1c (glycosylated hemoglobin A1c), LVEF, diabetes, hypertension, hyperlipidemia, smoking, drinking, white blood cell, TC(total cholesterol), LDL-C (low-density lipoprotein), HDL-C (high-density lipoprotein), Cr (creatinine), UA (uric acid), Cys C (Cystatin C), homocysteine, D-dimer, TnI (troponin I), and BNP (B-type natriuretic peptide) except for the stratified variables

Fig. 4

Forest plot displayed the clinical risk factors affecting the severity of coronary disease. Statistical methods and related abbreviations are the same as Fig. 3 (all P < 0.05%)

Fig. 5

Comparison of CASC in each coronary branch between non-multivessel and multivessel disease groups. CASC, coronary calcification score; LM, left main artery; LAD, left anterior descending branch; LCX, left circumflex branch; RCA, right coronary artery. Coronary artery calcification score expressed as a categorical variable: CACS < 62.36 (median value); CACS ≥ 62.36. vs. non-multivessel group, *P < 0.05, **P < 0.01

Fig. 6

Comparison of TyG indexes between non-MVCD and MVCD groups. TyG index, triglyceride-glucose index; non-MVCD, Non-multivessel coronary disease; MVCD, multivessel coronary disease. Non-multivessel disease was defined as at least 50% stenosis in one major coronary artery. Multivessel disease was defined as at least two major vessels (≥ 2 mm diameter) from different territories with lesions deemed angiographically significant (≥ 50% stenosis). vs. non-MVCD, *P < 0.05, **P < 0.01

Fig. 7

ROC curve analysis of TyG index or/and CASC to predict coronary disease severity. TyG index, triglyceride-glucose index; CASC, coronary artery calcium score

Fig. 8

Cumulative hazard function of different clinical endpoints according to TyG indexes. Kaplan–Meier curves demonstrated the cumulative hazard function of the primary endpoint (A), cardiovascular death (B), all-cause death (C), heart failure rehospitalization (D), Hospitalization for non-fatal myocardial infarction, angina and unplanned revascularization (E), and non-fatal stroke (F) among the 4 groups based on the TyG index quartiles. TyG index quartile 1 (Q1), 7.37–8.51; quartile 2 (Q2), 8.82–8.99; quartile 3 (Q3), 9.00–9.53; quartile 4 (Q4), 9.54–11.504. Except for the primary endpoint, the comparison of other clinical endpoints between Q1-Q4 groups reached significant differences (P < 0.05)