Association between non-insulin-based insulin resistance indices and cardiovascular events in patients undergoing percutaneous coronary intervention: a retrospective study

Abstract

Background: Insulin resistance (IR) has been confirmed that getting involved in the pathophysiological process of cardiovascular diseases (CVD). Recently, increasing evidence suggests metabolic score for insulin resistance (METS-IR), triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, triglyceride and glucose (TyG) index, triglyceride glucose-body mass (TyG-BMI) index are simple and reliable surrogates for IR. However, their abilities in predicting cardiovascular outcomes in patients undergoing percutaneous coronary intervention (PCI) are not well explored. Therefore, this study aimed to investigate the association and evaluate the predictive performance of each index.

Methods: A total of 2533 consecutive participants undergoing PCI were included in this study, and the data from 1461 patients were used to determine the correlation of these non-insulin-based IR indices with major adverse cardiac and cerebrovascular events (MACCEs) via performing the multivariate logistic models and restricted cubic splines (RCS).

Results: During a median of 29.8 months follow-up, 195 cases of 1461 patients experienced incident MACCEs. In the overall population, both univariate and multivariate logistic regression analyses indicated no statistically significant connection between these IR indices and MACCEs. Subgroup analyses revealed significant interactions between age subgroups and TyG-BMI index, as well as METS-IR, and between sex subgroups and TyG index. In elderly patients, per 1.0-SD increment in TyG-BMI index and METS-IR had a significant association with MACCEs, with odds ratios (ORs) [95% confidence interval (CI)] of 1.24 (1.02-1.50) and 1.27 (1.04-1.56), respectively (both P < 0.05). Moreover, in female patients, all the IR indices showed significant associations with MACCEs. Multivariable-adjusted RCS curves demonstrated a linear relationship between METS-IR and MACCEs in elderly and female patients, respectively. However, all the IR indices failed to enhance the predictive performance of the basic risk model for MACCEs.

Conclusion: All the four IR indices showed a significant association with MACCEs in female individuals, whereas only TyG-BMI index and METS-IR showed associations in elderly patients. Although the inclusion of these IR indices did not improve the predictive power of basic risk model in either female or elderly patients, METS-IR appears to be the most promising index for secondary prevention of MACCEs and risk stratification in patients undergoing PCI.

Keywords: Cardiovascular outcomes; Coronary artery disease; Insulin resistance; Metabolic score for insulin resistance; Percutaneous coronary intervention.

Fig. 1

The flowchart of study participants

Fig. 2

Association between IR indices and MACCEs among people undergoing PCI in different subgroups. Each subgroup was adjusted for age, hypertension, diabetes mellitus, heart failure, previous AMI, creatinine, uric acid, ACEI, number of diseased vessels, LAD, RCA, length of stents, and diameters of stents. Odds ratios are presented as per 1.0-SD increase in the IR indices for MACCEs. ACEI, angiotensin converting enzyme inhibitor; AMI, acute myocardial infraction; CI, confidence interval; IR, insulin resistance; LAD, left anterior descending; MACCEs, major adverse cardiac and cerebrovascular events; METS-IR, metabolic score for insulin resistance; RCA, right coronary artery; TG/HDL-C, triglyceride to high-density lipoprotein cholesterol ratio; TyG, triglyceride and glucose; TyG-BMI, triglyceride glucose-body mass index

Fig. 3

Restricted cubic spline curves for MACCEs by METS-IR after covariate adjustment. (A) Relationship in the elderly patients; (B) Relationship in the non-elderly patients; (C) Relationship in the female patients; (D) Relationship in the male patients. The threshold of statistical significance was set as P < 0.10. In A and B, age, heart failure, previous AMI, creatinine, uric acid, ACEI, number of diseased vessels, LAD, RCA, CTO, and length of stents were adjusted; in C and D, age, previous AMI, creatinine, uric acid, ACEI, number of diseased vessels, RCA, CTO, and length of stents were adjusted. Odds ratios are indicated by solid lines and 95% CIs by shaded areas. ACEI, angiotensin converting enzyme inhibitor; AMI, acute myocardial infraction; CI, confidence interval; CTO, chronic total occlusions; IR, insulin resistance; LAD, left anterior descending; MACCEs, major adverse cardiac and cerebrovascular events; METS-IR, metabolic score for insulin resistance; RCA, right coronary artery

Fig. 4

The receiver operating characteristic curves of the IR indices as a marker to predict MACCEs. (A) Basic risk model vs. + the IR indices in the elderly patients. Basic risk model includes age, heart failure, previous AMI, creatinine, uric acid, ACEI, number of diseased vessels, LAD, RCA, CTO, and length of stents; (B) Basic risk model vs. + the IR indices in the female patients. Basic risk model includes age, previous AMI, creatinine, uric acid, ACEI, number of diseased vessels, RCA, CTO, and length of stents. ACEI, angiotensin converting enzyme inhibitor; AMI, acute myocardial infraction; CI, confidence interval; CTO, chronic total occlusions; IR, insulin resistance; LAD, left anterior descending; MACCEs, major adverse cardiac and cerebrovascular events; METS-IR, metabolic score for insulin resistance; RCA, right coronary artery