Insulin sensitivity and cardiovascular risk after revascularization: associations with remodeling and long-term outcomes.

INTRODUCTION: Insulin resistance may influence myocardial recovery after ischemic injury, but its relevance to post-revascularization remodeling and long-term outcomes remains unclear. METHODS: We examined 732 patients with ischemic cardiomyopathy who underwent revascularization and had complete metabolic and echocardiographic data, with a median follow-up of 8.1 years. Insulin sensitivity was assessed using the Quantitative Insulin Sensitivity Check Index (QUICKI). Ventricular remodeling was evaluated by changes in LVEDD and LVESD. RESULTS: Across penalized regression and complementary machine-learning analyses, QUICKI consistently showed a stronger association with cardiovascular mortality than fasting glucose, insulin, or lipid measures. Lower QUICKI values were linked to greater ventricular dilatation, and these associations remained stable across analytic frameworks. Time-dependent ROC analysis demonstrated that QUICKI provided high early discriminatory performance for cardiovascular death. External validation in NHANES 2013-2016 further supported an inverse relationship between QUICKI and cardiovascular mortality risk. DISCUSSION: These findings suggest that insulin sensitivity, captured by a simple fasting-based index, reflects a metabolic vulnerability that relates to both structural remodeling and long-term prognosis after revascularization, aligning with the metabolic dimension of the CKM framework and offering a potential addition to contemporary risk-stratification strategies.