甘油三酯葡萄糖体重指数联合糖化血红蛋白对冠心病患者经皮冠状动脉介入治疗后支架内再狭窄的预测价值OA

Objective To investigate the predictive value of triglyceride-glucose-body mass index(TyG-BMI)combined with glycated hemoglobin(HbA1c)for in-stent restenosis(ISR)in patients with coronary heart disease(CHD)following percutaneous coronary intervention(PCI).Methods A retrospective analysis was conducted on the clinical data of 1908 patients diagnosed with CHD who underwent successful drug-eluting stent(DES)implantation at the Department of Cardiology,the First Hospital of Lanzhou University between January 1,2022,and December 31,2024,and received follow-up coronary angiography(CAG)9-12 months after surgery.According to the follow-up CAG findings,390 patients who developed ISR were assigned to ISR group,and 1518 patients without ISR to NISR group.Propensity score matching(PSM)was performed at a 1:2 ratio,yielding 848 matched patients,including 310 cases in ISR group and 538 cases in NISR group.Univariate and multivariate logistic regression analyses were performed to identify risk factors for ISR.The product term of TyG-BMI and HbA1c(TyG-BMI×HbA1c)was incorporated into the multivariate model to analyze their interaction effect.Multivariable-adjusted restricted cubic spline(RCS)analysis was conducted to evaluate the dose-response relationships of TyG-BMI and HbA1c with ISR risk,and threshold effect analysis was performed to identify potential inflection points.Receiver operating characteristic(ROC)curves were plotted,and the area under the curve(AUC)was calculated to assess the predictive efficacy of TyG-BMI and HbA1c for ISR.The DeLong test was applied to compare the differences in AUC between individual and combined indicators.Results After PSM,the levels of TyG-BMI and HbA1c in ISR group were significantly higher than those in NISR group(P<0.001).Univariate logistic regression analysis indicated that both TyG-BMI and HbA1c were correlated with ISR(P<0.001).Multivariate logistic regression analysis further verified that TyG-BMI(OR=1.03,95%CI 1.02-1.04)and HbA1c(OR=1.75,95%CI 1.49-2.07)were independent risk factors for ISR(P<0.001).ROC curve analysis and DeLong test results demonstrated that among the individual indicators,TyG-BMI had the best predictive performance for ISR(AUC=0.770,95%CI 0.736-0.804),superior to TyG(AUC=0.725)and HbA1c(AUC=0.742).The combined detection of TyG-BMI and HbA1c presented significantly higher predictive performance than any single indicator(combined AUC=0.810,95%CI 0.779-0.841,P<0.001).Multivariable-adjusted RCS analysis indicated a positive linear correlation between TyG-BMI and ISR(Pnon-linearity=0.431),while a non-linear association was observed between HbA1c and ISR(Pnon-linearity<0.001).Conclusion TyG-BMI and HbA1c are independent risk factors for ISR in CHD patients after PCI.Both have high predictive value for ISR,and their combination yields superior predictive performance.