甘油三酯-葡萄糖指数和甘油三酯-葡萄糖-BMI与急性冠脉综合征患者易损斑块的相关性研究OA

Background Triglyceride-glucose(TyG)index and triglyceride-glucose-body mass index(TyG-BMI)are considered to be alternative indicators of insulin resistance(IR)and have been shown to be associated with cardiovascular disease.However,evidence regarding their correlations with atherosclerotic plaque characteristics in patients with acute coronary syndrome(ACS)remains limited.Objective This study aimed to investigate the associations of the TyG index and TyG-BMI with vulnerable plaque at the culprit lesion in patients with ACS.Methods A total of 577 patients with ACS who were admitted to Central China Fuwai Hospital of Zhengzhou University from June 2020 to December 2023 were enrolled retrospectively.All patients underwent coronary angiography and optical coherence tomography(OCT)image.According to the diagnostic criteria of thin-cap fibroatheroma(TCFA),patients were divided into non-TCFA group(339 cases)and TCFA group(238 cases).The baseline data coronary angiography results and OCT images were compared.Multivariate Logistic regression was performed to identify factors associated with TCFA.Subgroup analyses were conducted according to glycemic status.The receiver operating characteristic(ROC)curves of TyG index and TyG-BMI index in the diagnosis of TCFA in different subgroups was analyzed,and the area under the ROC curve(AUC)of the two indexes in each subgroup was calculated to evaluate the diagnostic efficacy.Results The TyG index[9.01(8.60,9.50)vs.8.58(8.19,8.92),P<0.001]and TyG-BMI index[239.96(217.72,264.50)vs.218.81(198.02,242.60),P<0.001]in the TCFA group were higher than those in the non-TCFA group.The proportions of macrophage infiltration,plaque rupture,and punctate calcification in the TCFA group were higher than those in the non-TCFA group(P<0.05).After adjusting for confounding factors,the results of multivariate Logistic regression analysis showed that elevated TyG index(OR=4.216,95%CI=2.924-6.079,P<0.001)and TyG-BMI index(OR=1.011,95%CI=1.005-1.016,P<0.001)were risk factors for TCFA occurrence.Patients were divided into diabetic subgroups,prediabetic subgroups,and non-diabetic subgroups based on different glucose metabolic states,with 284 cases,212 cases,and 81 cases respectively.Subgroup analysis showed that elevated TyG index was a risk factor for TCFA occurrence in different glucose metabolic states,while elevated TyG-BMI index was only a risk factor for TCFA occurrence in the diabetic subgroup(P<0.05).The ROC curves results showed that the AUCs of the TyG index and TyG-BMI index for predicting TCFA occurrence in the diabetic subgroup were 0.729 and 0.660,respectively;in the prediabetic subgroup,they were 0.695 and 0.634,respectively;and in the non-diabetic subgroup,they were 0.697 and 0.629,respectively.Conclusion Both the TyG index and TyG-BMI are associated with the presence of vulnerable plaque in ACS patients.The TyG index demonstrates superior diagnostic value over TyG-BMI for predicting vulnerable coronary atherosclerotic plaques in ACS patients.