Metabolic score for insulin resistance predicts major adverse cardiovascular event in premature coronary artery disease

Abstract

Background: The Metabolic Score for Insulin Resistance (METS-IR) index serves as a simple surrogate marker for insulin resistance (IR) and is associated with the presence and severity of coronary artery disease (CAD). However, the prognostic significance of METS-IR in patients with premature CAD remains unclear. This study aims to investigate the prognostic value of METS-IR in premature CAD.

Methods: This retrospective study included 582 patients diagnosed with premature CAD between December 2012 and July 2019. The median follow-up duration was 63 months (interquartile range, 44-81 months). The primary endpoint was Major Adverse Cardiovascular Events (MACE), defined as a composite of all-cause death, non-fatal myocardial infarction (MI), repeat coronary artery revascularization, and non-fatal stroke.

Results: Patients with MACE had significantly higher METS-IR levels than those without MACE (44.88±8.11 vs. 41.68±6.87, p<0.001). Kaplan-Meier survival curves based on METS-IR tertiles demonstrated a statistically significant difference (log-rank test, p<0.001). In the fully adjusted model, the Hazard Ratio (95% CI) for MACE was 1.41 (1.16-1.72) per SD increase in METS-IR, and the P for trend based on METS-IR tertiles was 0.001 for MACE. Time-dependent Receiver Operator Characteristic (ROC) analysis of METS-IR yielded an Area Under the Curve (AUC) of 0.74 at 2 years, 0.69 at 4 years, and 0.63 at 6 years.

Conclusions: METS-IR serves as a reliable prognostic predictor of MACE in patients with premature CAD. Therefore, METS-IR may be considered a novel, cost-effective, and dependable indicator for risk stratification and early intervention in premature CAD.

Keywords: insulin resistance; major adverse cardiovascular events; metabolic score for insulin resistance; premature coronary artery disease; prognosis.

Figure 1

Flow diagram of patient selection. ^& Including severe cardiac value disease, decompensated heart failure, non-ischemic dilated cardiomyopathy, severe renal or hepatic disease, acute infection or inflammation, malignancy, hematologic disease or autoimmune disease.

Figure 2

Kaplan–Meier survival curve for MACE and secondary endpoints across the METS-IR tertiles. (A) Significance was found between MACE and METS-IR tertiles. (B–E) Cumulative incidence curves for all-cause death, non-fatal infarction, repeat coronary artery revascularization and non-fatal shock, respectively. METS-IR tertiles were significantly associated with repeat coronary artery revascularization and non-fatal MI. There was no significance in all-cause death and non-fatal stroke. METS-IR, metabolic score for insulin resistance; MACE, major adverse cardiovascular events.

Figure 3

Subgroup and interaction analysis between METS-IR (Per SD) and MACE in various subgroup. METS-IR, metabolic score for insulin resistance; MACE, major adverse cardiovascular events.

Figure 4

Time-dependent ROC curves of the METS-IR for the prediction of MACE. ROC curve, receiver operating characteristic curve; METS-IR, metabolic score for insulin resistance; MACE, major adverse cardiovascular events; AUC, area under the curves.