The triglyceride-glucose index predicts 1-year major adverse cardiovascular events in end-stage renal disease patients with coronary artery disease

Abstract

Background: The triglyceride-glucose (TyG) index has been suggested as a dependable indicator for predicting major adverse cardiovascular events (MACE) in individuals with cardiovascular conditions. Nevertheless, there is insufficient data on the predictive significance of the TyG index in end-stage renal disease (ESRD) patients with coronary artery disease (CAD).

Methods: This study, conducted at multiple centers in China, included 959 patients diagnosed with dialysis and CAD from January 2015 to June 2021. Based on the TyG index, the participants were categorized into three distinct groups. The study's primary endpoint was the combination of MACE occurring within one year of follow-up, including death from any cause, non-fatal myocardial infarction, and non-fatal stroke. We assessed the association between the TyG index and MACE using Cox proportional hazard models and restricted cubic spline analysis. The TyG index value was evaluated for prediction incrementally using C-statistics, continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

Results: The three groups showed notable variations in the risk of MACE (16.3% in tertile 1, 23.5% in tertile 2, and 27.2% in tertile 3; log-rank P = 0.003). Following complete adjustment, patients with the highest TyG index exhibited a notably elevated risk of MACE in comparison to those in the lowest tertile (hazard ratio [HR] 1.63, 95% confidence interval [CI] 1.14-2.35, P = 0.007). Likewise, each unit increase in the TyG index correlated with a 1.37-fold higher risk of MACE (HR 1.37, 95% CI 1.13-1.66, P = 0.001). Restricted cubic spline analysis revealed a connection between the TyG index and MACE (P for nonlinearity > 0.05). Furthermore, incorporating the TyG index to the Global Registry of Acute Coronary Events risk score or baseline risk model with fully adjusted factors considerably enhanced the forecast of MACE, as demonstrated by the C-statistic, continuous NRI, and IDI.

Conclusions: The TyG index might serve as a valuable and dependable indicator of MACE risk in individuals with dialysis and CAD, indicating its potential significance in enhancing risk categorization in clinical settings.

Keywords: Coronary artery disease; End-stage renal disease; Insulin resistance; Major adverse cardiovascular events; Triglyceride-glucose index.

Fig. 1

Flow diagram of patient’s selection. TyG, triglyceride-glucose index; MACE, major adverse cardiovascular events

Fig. 2

Kaplan–Meier Estimated Event Rates of major adverse cardiovascular events according to tertiles of the triglyceride-glucose index. MACE, major adverse cardiovascular events

Fig. 3

Restricted cubic spline curves of the association between triglyceride-glucose index and major adverse cardiovascular events. A Unadjusted model. B fully adjusted model. Hazard ratios are indicated by solid red lines and 95% CIs are indicated by shaded areas. CI, confidence interval; TyG, triglyceride-glucose index

Fig. 4

Subgroup Analyses for major adverse cardiovascular events. AMI, acute myocardial infarction; CI, confidence interval; HR, hazard ratio; PCI, percutaneous coronary intervention