Vital Predictive and Prognostic Roles of Triglyceride-Glucose Index in Women With Acute Myocardial Infarction: A Retrospective Cohort Study

Abstract

Background and aims: As a biomarker of insulin resistance (IR) in patients with acute myocardial infarction (AMI), the triglyceride-glucose index (TyG index) has received significant attention. However, most research on AMI has focused on male patients, as it is traditionally believed to primarily affect males. Therefore, this study was conducted on a female population with AMI to investigate the potential correlation between the TyG index and their outcomes.

Methods: A total of 320 women who were admitted to Fujian Provincial Hospital for AMI between January 2017 and December 2019 were included in this study. The TyG index was calculated using the following formula: ln [fasting triglycerides (TG) (mg/dL) × fasting plasma glucose (FPG) (mg/dL)/2]. The primary endpoint of the study was the occurrence of major adverse cardiovascular and cerebrovascular events (MACCEs), which included all-cause mortality, myocardial infarction, repeat revascularization, rehospitalization for heart failure and stroke. The association between the TyG index and unfavorable outcomes in female patients was investigated using the Cox proportional hazards regression model.

Results: It was ultimately estimated that 111 patients developed MACCEs. Females with high TyG indices had a higher prevalence of diabetes, elevated heart rates, and hemoglobin A1c, as well as a higher likelihood of undergoing thrombus aspiration and stent placement. The TyG index was found to be positively correlated with the prevalence of hypertension, diabetes, low-density lipoprotein cholesterol, hemoglobin A1c, and damaged vessels. However, this correlation was modest, yet statistically significant. Furthermore, after adjusting for conventional risk factors, the TyG index (HR: 4.292, 95% CI: 2.784-6.616, p < 0.001) was independently associated with MACCEs.

Conclusion: As an independent risk predictor, the TyG index has the potential to enhance clinical outcomes for women with AMI.

Keywords: acute myocardial infarction (AMI); female; insulin resistance (IR); major adverse cardiac and cerebral events (MACCEs); triglyceride‐glucose index (TyG index).

Chart 1

A flow chart of specific criteria for inclusion and exclusion.

Figure 1

Correlations between TyG index and (A) heart rate, (B) HbA1c, (C) LDL, (D) HDL were evaluated via Spearman's correlation analysis in the whole patients. The p value < 0.05 is considered as significant. Spearman's correlation coefficients (abbreviated r) range from −1 to +1. The sign of the coefficient indicates whether it is a positive or negative monotonic relationship. A positive correlation means that as one variable increases, the other variable also tends to increase. A negative correlation signifies that as one variable increases, the other tends to decrease. Values close to −1 or +1 represent stronger relationships than values closer to zero. HbA1c, Hemoglobin A1c; HDL‐C, high‐density lipoprotein cholesterol; LDL, low‐density lipoprotein cholesterol; TyG index, triglyceride‐glucose index.

Figure 2

The receiver operating characteristic (ROC) curves of the TyG index, SYNTAX score and HbA1c. The area under ROC curves (AUCs) of the TyG index, SYNTAX score and HbA1c are 0.701,0.578 and 0.648. HbA1c, hemoglobin A1c; TyG index, triglyceride‐glucose index.

Figure 3

Survival outcomes in women with acute myocardial infarction stratified by TyG index. (A) Endpoints survival, (B) all‐cause mortality survival, (C) myocardial infarction survival, (D) repeat revascularization survival, (E) rehospitalization related to heart failure survival, and (F) stroke survival between low and high TyG index. The p value < 0.05 is considered as significant. TyG index, triglyceride‐glucose index; HR, hazard ratio. TyG=1: A high TyG index, TyG=0: A low TyG index.

Figure 4

Survival outcomes in women with ST‐segment elevation myocardial infarction stratified by TyG index. (A) Endpoints survival, (B) all‐cause mortality survival, (C) myocardial infarction survival, (D) repeat revascularization survival, (E) rehospitalization related to heart failure survival, and (F) stroke survival between low and high TyG index. The p value < 0.05 is considered as significant. HR, hazard ratio; TyG index, triglyceride‐glucose index. TyG=1: A high TyG index, TyG=0: A low TyG index.

Figure 5

Survival outcomes in women with non‐ST‐segment elevation myocardial infarction stratified by TyG index. (A) Endpoints survival, (B) all‐cause mortality survival, (C) myocardial infarction survival, (D) repeat revascularization survival, (E) rehospitalization related to heart failure survival, and (F) stroke survival between low and high TyG index. The p value < 0.05 is considered as significant. HR, hazard ratio; TyG index, triglyceride‐glucose index. TyG=1: A high TyG index, TyG=0: A low TyG index.

Figure 6

Cox proportional hazards analysis evaluating prognostic implication of TyG index in various stratifications. The p value < 0.05 is considered as significant. TyG index, triglyceride‐glucose index.