Association Between Triglyceride-Glucose Index and 2-Year Adverse Cardiovascular and Cerebrovascular Events in Patients with Type 2 Diabetes Mellitus Who Underwent Off-Pump Coronary Artery Bypass Grafting

Figures & data

Figure 1 Flow chart of the study population enrollment.

Abbreviations: CABG, coronary artery bypass graft; FPG, fasting plasma glucose; T1DM, type 1 diabetes mellitus; TGs, triglycerides; BMI, body mass index; TyG, triglyceride glucose.

Table 1 Baseline Clinical and Laboratory Characteristics and of the Study Patients Stratified by the Tertiles of TyG Index

	T1 n=526	T2 n=526	T3 n=526	p
TyG index	8.45 (0.31)	9.11 (0.15)	9.83 (0.34)	<0.001
Age (years)	62.6 (7.5)	63.0 (7.8)	63.2 (8.7)	0.434
Sex, male, n (%)	365 (69.4)	379 (72.1)	372 (70.7)	0.638
BMI (kg/m^2)	25.17 (2.96)	26.09 (2.98)	26.65 (3.25)	<0.001
SBP (mmHg)	129.84 (16.17)	131.36 (17.95)	129.63 (15.84)	0.187
DBP (mmHg)	73.37 (10.86)	74.00 (10.91)	74.94 (10.11)	0.055
Current smoking, n (%)	136 (25.9)	152 (28.9)	164 (31.2)	0.160
Hypertension, n (%)	387 (73.6)	374 (71.1)	372 (70.7)	0.536
Dyslipidemia, n (%)	155 (29.5)	160 (30.4)	204 (38.8)	0.002
Previous MI, n (%)	61 (11.6)	73 (13.9)	94 (17.9)	0.014
Previous stroke, n (%)	36 (6.8)	48 (9.1)	65 (12.4)	0.009
Past PCI, n (%)	115 (21.9)	117 (22.2)	139 (26.4)	0.153
Cardiac failure, n (%)	16 (3.0)	20 (3.8)	22 (4.2)	0.606
CKD, n (%)	17 (3.2)	17 (3.2)	31 (5.9)	0.043
Preoperative LVEF (%)	59.64 (7.26)	59.55 (7.75)	59.31 (7.97)	0.768
Insulin dependence, n (%)	127 (24.1)	151 (28.7)	167 (31.7)	0.022
TC (mg/dl)	130.70 [111.70, 154.60]	141.70 [123.30, 163.50]	153.30 [129.90, 178.80]	<0.001
TGs (mg/dl)	87.80 [70.00, 104.60]	130.30 [108.43, 154.08]	202.10 [156.90, 260.70]	<0.001
FPG (mg/dl)	110.30 [95.00, 125.30]	135.00 [118.65, 165.55]	179.00 [145.33, 227.95]	<0.001
LDL-C (mg/dl)	75.40 [60.30, 94.30]	84.10 [67.88, 102.10]	87.95 [69.70, 109.80]	<0.001
HDL-C (mg/dl)	37.90 [33.20, 44.80]	36.10 [32.50, 42.58]	34.40 [29.80, 39.00]	<0.001
Diagnosis
Stable CAD, n (%)	1 (0.2)	2 (0.4)	3 (0.6)	0.605
UA, n (%)	495 (94.1)	485 (92.2)	461 (87.6)	0.001
STEMI, n (%)	19 (3.6)	26 (4.9)	38 (7.2)	0.030
NSTEMI, n (%)	11 (2.1)	13 (2.5)	24 (4.6)	0.042
Extent of CAD
1-vessel disease, n (%)	52 (9.9)	44 (8.4)	35 (6.7)	0.164
2-vessel disease, n (%)	94 (17.9)	86 (16.3)	70 (13.3)	0.119
3-vessel disease, n (%)	383 (72.8)	396 (75.3)	430 (81.7)	0.002
Left main disease, n (%)	57 (10.8)	55 (10.5)	74 (14.1)	0.136
Use of arterial graft, n (%)	392 (74.5)	388 (73.8)	374 (71.1)	0.421
Complete revascularization, n (%)	511 (97.1)	509 (96.8)	509 (96.8)	0.919
Use of IABP, n (%)	17 (3.2)	19 (3.6)	20 (3.8)	0.878

Abbreviations: TyG, triglyceride glucose; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; MI, myocardial infarction; PCI, percutaneous coronary intervention; CKD, chronic kidney disease; LVEF, left ventricular ejection fraction; TC, total cholesterol; TGs, triglycerides; FPG, fasting plasma glucose; LDL-C, low-density lipoprotein-cholesterol; HDL-C, high-density lipoprotein-cholesterol; CAD, coronary artery disease; UA, unstable angina; STEMI, ST-segment elevation myocardial infarction; NSTEMI, non ST-segment elevation myocardial infarction; IABP, intra-aortic balloon pump.

Table 2 Baseline TyG Index and Prediction of Cardiovascular and Cerebrovascular Events

Endpoint	Baseline TyG Index	2-Year Events, n (%)	Unadjusted HR (95% CI)	P value	Adjusted HR (95% CI)	P value
All-cause death	Tertile 1	5 (0.95)	Ref.	0.941	Ref.	0.730
	Tertile 2	6 (1.14)	1.2 (0.366–3.933)	0.763	0.947 (0.274–3.272)	0.932
	Tertile 3	6 (1.14)	1.209 (0.369–3.962)	0.754	0.61 (0.153–2.431)	0.483
P trend			0.757		0.472
Nonfatal MI	Tertile 1	4 (0.76)	Ref.	0.012	Ref.	0.034
	Tertile 2	15 (2.85)	3.787 (1.257–11.412)	0.018	3.47 (1.14–10.564)	0.029
	Tertile 3	20 (3.80)	5.130 (1.754–15.01)	0.003	4.351 (1.436–13.182)	0.009
P trend			0.002		0.010
Nonfatal stroke	Tertile 1	7 (1.33)	Ref.	0.026	Ref.	0.275
	Tertile 2	12 (2.28)	1.727 (0.68–4.387)	0.250	1.409 (0.538–3.691)	0.485
	Tertile 3	21 (3.99)	3.065 (1.303–7.209)	0.010	2.077 (0.81–5.326)	0.128
P trend			0.007		0.110
Symptomatic graft failure	Tertile 1	11 (2.09)	Ref.	<0.001	Ref.	0.011
	Tertile 2	28 (5.32)	2.579 (1.284–5.179)	0.008	2.625 (1.275–5.405)	0.009
	Tertile 3	40 (7.60)	3.815 (1.958–7.436)	<0.001	2.987 (1.44–6.195)	0.003
P trend			<0.001		0.005
MACCE	Tertile 1	29 (5.51)	Ref.	<0.001	Ref.	0.005
	Tertile 2	59 (11.22)	2.095 (1.343–3.268)	0.001	1.726 (1.093–2.725)	0.019
	Tertile 3	88 (16.73)	3.297 (2.167–5.016)	<0.001	2.133 (1.347–3.377)	0.001
P trend			<0.001		0.005

Abbreviations: TyG, triglyceride glucose; MI, myocardial infarction; MACCE, major adverse cardiovascular and cerebrovascular events.

Figure 2 The TyG index and risk: Kaplan–Meier curves for the incidences of the primary endpoint (A), symptomatic graft failure (B), all-cause death (C), non-fatal MI (D), and non-fatal stroke (E) among the three study groups based on the TyG index tertiles.

Abbreviations: MI, myocardial infarction; OPCABG, off-pump coronary artery bypass graft.

Table 3 Relationship Between the Incidence of the Primary Endpoint and the TyG Index Expressed as a Continuous Variable

Variables	Univariate Analysis HR (95% CI)	P value	Multivariate Analysis HR (95% CI)	P value
TyG index	2.624 (2.076–3.316)	<0.001	1.954 (1.508–2.533)	<0.001
Age	1.018 (0.999–1.037)	0.065	1.013 (0.992–1.034)	0.224
Sex, male	0.729 (0.536–0.993)	0.045	0.766 (0.556–1.055)	0.103
BMI	1.071 (1.024–1.121)	0.003	1.039 (0.991–1.09)	0.116
Current smoking	1.048 (0.758–1.448)	0.778	0.933 (0.668–1.305)	0.686
Hypertension	1.084 (0.776–1.514)	0.636	1.12 (0.791–1.587)	0.523
Previous MI	1.416 (0.970–2.067)	0.072	1.322 (0.887–1.971)	0.170
Previous stroke	1.936 (1.293–2.900)	0.001	1.643 (1.084–2.492)	0.019
Past PCI	1.087 (0.773–1.529)	0.631	0.97 (0.681–1.382)	0.866
Cardiac failure	1.850 (1.005–3.406)	0.048	2.016 (0.871–4.666)	0.102
CKD	1.129 (0.556–2.295)	0.737	0.832 (0.403–1.72)	0.620
Preoperative LVEF	0.994 (0.975–1.013)	0.521	1.011 (0.987–1.035)	0.372
Insulin dependence	1.314 (0.961–1.798)	0.087	1.168 (0.849–1.607)	0.340
LDL-C	1.005 (1.001–1.01)	0.016	1.003 (0.998–1.007)	0.244
HDL-C	0.952 (0.933–0.97)	<0.001	0.973 (0.953–0.995)	0.014
Diagnosis
Stable CAD	Ref.		Ref.
UA	0.611 (0.085–4.364)	0.623	0.421 (0.055–3.247)	0.407
STEMI	0.608 (0.076–4.858)	0.639	0.359 (0.042–3.083)	0.350
NSTEMI	4.208 (0.571–31.014)	0.159	2.167 (0.274–17.119)	0.463
Extent of CAD
1-vessel disease	Ref.		Ref.
2-vessel disease	0.611 (0.085–4.364)	0.623	0.727 (0.315–1.678)	0.455
3-vessel disease	0.608 (0.076–4.858)	0.639	1.427 (0.718–2.838)	0.310
Left main disease	4.208 (0.571–31.014)	0.159	0.641 (0.38–1.082)	0.096
Use of arterial graft	1.483 (0.759–2.901)	0.249	1.042 (0.733–1.481)	0.819
Complete revascularization	0.505 (0.281–0.908)	0.022	0.327 (0.176–0.61)	<0.001
Use of IABP	1.483 (0.759–2.901)	0.249	1.429 (0.695–2.94)	0.332

Abbreviations: TyG, triglyceride glucose; BMI, body mass index; MI, myocardial infarction; PCI, percutaneous coronary intervention; CKD, chronic kidney disease; LVEF, left ventricular ejection fraction; LDL-C, low-density lipoprotein-cholesterol; HDL-C, high-density lipoprotein-cholesterol; CAD, coronary artery disease; UA, unstable angina; STEMI, ST-segment elevation myocardial infarction; NSTEMI, non ST-segment elevation myocardial infarction; IABP, intra-aortic balloon pump.

Table 4 Relationship Between the Incidence of the Primary Endpoint and the TyG Index Expressed as a Categorical Variable

Variables	Univariate Analysis HR (95% CI)	P value	Multivariate Analysis HR (95% CI)	P value
TyG index tertiles
T1	Ref.		Ref.
T2	2.095 (1.343–3.268)	0.001	1.726 (1.093–2.725)	0.019
T3	3.297 (2.167–5.016)	<0.001	2.133 (1.347–3.377)	0.001
Age	1.018 (0.999–1.037)	0.065	1.016 (0.995–1.038)	0.132
Sex, male	0.729 (0.536–0.993)	0.045	0.755 (0.549–1.04)	0.085
BMI	1.071 (1.024–1.121)	0.003	1.045 (0.996–1.098)	0.072
Current smoking	1.048 (0.758–1.448)	0.778	0.963 (0.69–1.344)	0.823
Hypertension	1.084 (0.776–1.514)	0.636	1.075 (0.76–1.522)	0.683
Previous MI	1.416 (0.970–2.067)	0.072	1.299 (0.871–1.938)	0.200
Previous stroke	1.936 (1.293–2.900)	0.001	1.624 (1.071–2.465)	0.023
Past PCI	1.087 (0.773–1.529)	0.631	0.96 (0.674–1.367)	0.821
Cardiac failure	1.850 (1.005–3.406)	0.048	2.162 (0.933–5.009)	0.072
CKD	1.129 (0.556–2.295)	0.737	0.861 (0.416–1.783)	0.687
Preoperative LVEF	0.994 (0.975–1.013)	0.521	1.009 (0.986–1.034)	0.447
Insulin dependence	1.314 (0.961–1.798)	0.087	1.189 (0.866–1.634)	0.284
LDL-C (mg/dl)	1.005 (1.001–1.01)	0.016	1.003 (0.999–1.008)	0.176
HDL-C (mg/dl)	0.952 (0.933–0.97)	<0.001	0.966 (0.946–0.988)	0.002
Diagnosis
Stable CAD	Ref.		Ref.
UA	0.611 (0.085–4.364)	0.623	0.467 (0.06–3.604)	0.465
STEMI	0.608 (0.076–4.858)	0.639	0.416 (0.048–3.572)	0.424
NSTEMI	4.208 (0.571–31.014)	0.159	2.689 (0.34–21.246)	0.348
Extent of CAD
1-vessel disease	Ref.		Ref.
2-vessel disease	0.611 (0.085–4.364)	0.623	0.686 (0.297–1.586)	0.379
3-vessel disease	0.608 (0.076–4.858)	0.639	1.411 (0.709–2.807)	0.327
Left main disease	4.208 (0.571–31.014)	0.159	0.634 (0.376–1.07)	0.088
Use of arterial graft	1.483 (0.759–2.901)	0.249	1.035 (0.729–1.47)	0.846
Complete revascularization	0.505 (0.281–0.908)	0.022	0.306 (0.163–0.574)	<0.001
Use of IABP	1.483 (0.759–2.901)	0.249	1.397 (0.675–2.893)	0.368

Abbreviations: TyG, triglyceride glucose; BMI, body mass index; MI, myocardial infarction; PCI, percutaneous coronary intervention; CKD, chronic kidney disease; LVEF, left ventricular ejection fraction; LDL-C, low-density lipoprotein-cholesterol; HDL-C, high-density lipoprotein-cholesterol; CAD, coronary artery disease; UA, unstable angina; STEMI, ST-segment elevation myocardial infarction; NSTEMI, non ST-segment elevation myocardial infarction; IABP, intra-aortic balloon pump.