SA JOURNAL OF DIABETES & VASCULAR DISEASE RESEARCH ARTICLE VOLUME 21 NUMBER 1 • November 2024 19 Table 5. Sensitivity analysis of TyG index for the severity and MACE of PCAD Youden Cut-off Variables Sensitivity pecificity index value AUC Gensini score 0.678 0.801 0.479 9.252 0.833 MACE 0.500 0.955 0.495 9.918 0.807 AUC: area under curve, MACE: major adverse cardiovascular events. CAG is the gold standard for the diagnosis of CAD, but it is a costly and invasive procedure.10 Therefore exploring a relatively simple, economical, reliable, non-invasive biomarker to predict the severity of CAD would benefit patients, and would also be of great significance for prevention and control of the disease, and reducing the medical burden. The TyG index, which is a composite indicator composed of fasting TG and FBG levels, is a simple and reliable surrogate for IR, which has been proven to be a risk factor for cardiovascular disease.11 In this study we grouped the enrolled patients based on the tertiles of the TyG index. The results showed sequential increases from low to high in the differences of BMI, FBG, TC, TG and LDL-C of different TyG level groups. The opposite trend was found for HDL-C levels. These data revealed disorders of glucose and lipid metabolism in the studied patients. The metabolic disorder is one of the main causes of CAD, and can affect the development of CAD.12 In our study we also found that with an increase in TyG index, the risk of severe CAD in PCAD patients gradually increased, and this relationship still existed after adjusting for related confounding factors. Li et al. recruited asymptomatic subjects with type 2 diabetes who underwent coronary CT angiography, and the authors found that the incidence of severe coronary stenosis increased along with the TyG index tertiles. These results indicated that the highest and middle tertiles of the TyG index were independently associated with the severity of CAD after adjustment for other related confounding factors.13 Mao et al. evaluated 438 patients with non-ST-elevation acute coronary syndrome and found the TyG index was an independent predictor of a high SYNTAX score (OR: 6.055, 95% CI: 2.915– 12.579). With an increase in the TyG index, the degree of coronary artery stenos also increased.14 Thai et al. found that a higher TyG index was associated with the number of narrowed coronary arteries and the degree of coronary stenosis.15 These earlier studies are consistent with the results of our study, which showed that the TyG index was associated with the severity of CAD in these Table 3. Multivariable logistic regression analyses for MACE Variables β SE Wald OR 95% CI p-value Smoking 0.870 0.427 4.152 2.387 1.034–5.510 0.042 Drinking –0.268 0.449 0.355 0.765 0.318–1.844 0.551 Hypertension 0.768 0.337 5.199 2.156 1.114–4.172 0.023 Diabetes 0.855 0.365 5.496 2.351 1.151–4.805 0.019 BMI –0.055 0.058 0.906 0.946 0.844–1.060 0.341 HDL-C –2.037 0.931 4.792 0.130 0.021–0.808 0.029 TyG 1. 538 0.309 24.799 4.653 2.541–8.522 < 0.001 BMI: body mass index, HDL-C: high-density lipoprotein cholesterol, TyG: triglyceride–glucose index. Table 4. Comparison of MACE with different TyG levels T1 group T2 group T3 group Variables (n = 100) (n = 100) (n = 100) χ2 p-value Re-admission, n (%) 10 (10.00) 24 (24.00) 46 (46.00) 33.682 < 0.001 Coronary artery revascularisation, n (%) 3 (3.00) 7 (7.00) 18 (18.00) 14.259 0.001 In-stent restenosis, n (%) 0 (0.00) 2 (2.00) 6 (6.00) 6.566 0.031 Heart failure, n (%) 0 (0.00) 0 (0.00) 2 (2.00) 2.655 0.331 Arrhythmia, n (%) 0 (0.00) 1 (1.00) 1 (1.00) 1.249 1.000 Haemorrhagic events, n (%) 0 (0.00) 0 (0.00) 1 (1.00) 1.824 1.000 Fig. 2. ROC curve of TyG index for severity of PCAD and MACE.
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