Triglyceride-glucose index correlates with the occurrence and prognosis of acute myocardial infarction complicated by cardiogenic shock: data from two large cohorts

Abstract

Background: Triglyceride-glucose (TyG) index, a dependable indicator of insulin resistance, has been identified as a valid marker regarding multiple cardiovascular diseases. Nevertheless, the correlation of TyG index with acute myocardial infarction complicated by cardiogenic shock (AMICS) remains uncertain. Our study aims for elucidating this relationship by comprehensively analyzing two large-scale cohorts.

Methods: Utilizing records from the eICU Collaborative Research Database and the Medical Information Mart for Intensive Care IV, the link between TyG and the incidence and prognosis of AMICS was assessed multicentrally and retrospectively by logistic and correlation models, as well as restricted cubic spline (RCS). Propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and overlap weighting (OW) were employed to balance the potential confounders. Subgroup analyses were performed according to potential modifiers.

Results: Overall, 5208 AMI patients, consisting of 375 developing CS were finally included. The TyG index exhibited an apparently higher level in AMI populations developing CS than in those who did not experienced CS [9.2 (8.8-9.7) vs. 9.0 (8.5-9.5)], with a moderate discrimination ability to recognize AMICS from the general AMI (AUC: 0.604). Logistic analyses showed that the TyG index was significantly correlated with in-hospital and ICU mortality. RCS analysis demonstrated a linear link between elevated TyG and increased risks regarding in-hospital and ICU mortality in the AMICS population. An increased mortality risk remains evident in PSM-, OW- and IPTW-adjusted populations with higher TyG index who have undergone CS. Correlation analyses demonstrated an apparent link between TyG index and APS score. Subgroup analyses presented a stable link between elevated TyG and mortality particularly in older age, females, those who are overweight or hypertensive, as well as those without diabetes.

Conclusions: Elevated TyG index was related to the incidence of CS following AMI and higher mortality risks in the population with AMICS. Our findings pointed a previously undisclosed role of TyG index in regard to AMICS that still requires further validation.

Keywords: Acute myocardial infarction; Cardiogenic shock; Insulin resistance; Triglyceride-glucose index.

Fig. 1

Flow diagram of patient selection from MIMIC-IV and eICU databases. AMI, acute myocardial infarction; CS, cardiogenic shock; TG, triglyceride; FBG, fasting blood glucose

Fig. 2

Endpoints stratified by tertiles of TyG index in the AMICS population. A in-hospital mortality; B ICU mortality; C LOS-H; D LOS-ICU. ICU, intensive unit care; LOS-H, length of stay in hospital; LOS-ICU, length of stay in intensive unit care

Fig. 3

ROC curve of the TyG index regarding identifying acute myocardial infarction complicated by cardiogenic shock from the overall acute myocardial infarction. ROC, receiver operator characteristic; TyG index, triglyceride-glucose index; AUC, area under the curve; CI, confidence interval

Fig. 4

RCS curves of the TyG index in relation to mortality among patients with acute myocardial infarction complicated by cardiogenic shock. A in-hospital mortality; B ICU mortality. ICU, intensive unit care; TyG index, triglyceride-glucose index; CI, confidence interval

Fig. 5

The comparison of ICU mortality, in-hospital mortality, and alive to discharge rates between the lower and higher TyG index groups in the original, PSM-matched, IPTW-adjusted, and OW-adjusted AMICS populations. ICU, intensive unit care; TyG, triglyceride-glucose; PSM, propensity score matching; IPTW, inverse probability of treatment weighting; OW, overlap weighting

Fig. 6

Subgroup analyses for the association between the TyG index and mortality. based on age, gender, BMI, cardiac arrest, diabetes mellitus, and hypertension. A in-hospital mortality; B ICU mortality. BMI, body mass index