Yang Yang, Leilei Liu, Xiuyu Liang, Xiaohong Zhang, Hai Xu
TyG and IBI were independently associated with AMR-defined CMD and 12-month MACE after STEMI. Adding TyG and IBI to conventional clinical and procedural factors improved model discrimination for CMD, although prospective multicenter validation is required before clinical application.
BACKGROUND: Metabolic dysfunction and inflammation may jointly contribute to coronary microvascular injury and adverse outcomes after primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI). We examined the independent and combined associations of the triglyceride-glucose (TyG) index and inflammatory burden index (IBI) with angiographic microvascular resistance (AMR)-defined coronary microvascular dysfunction (CMD), their incremental value beyond conventional factors, and their associations with 12-month major adverse cardiovascular events (MACE).
METHODS: In this retrospective cohort study conducted at a single center, 318 STEMI patients who underwent PPCI and achieved a TIMI grade 3 flow post-procedure were enrolled. AMR was derived from the final post-PPCI angiogram of the culprit vessel, and CMD was defined as AMR >26.6 mmHg·s/dm. Multivariable models assessed associations with CMD and MACE. Sequential models evaluated the incremental performance of TyG and IBI with 1,000-resample bootstrap internal validation.
RESULTS: CMD was present in 102/318 (32.1%). TyG (OR per 1-unit, 3.83; 95% CI, 2.04-7.21; P<0.001) and IBI (OR per 10-units, 1.13; 95% CI, 1.07-1.20; P<0.001) were independently associated with CMD. The TyG-IBI model showed an AUC of 0.773 for CMD; adding both to a clinical/procedural model improved the AUC from 0.904 to 0.939 (bootstrap-validated, 0.920; ΔAUC, 0.036; P = 0.001). Over 12 months, 69 (21.7%) patients had MACE. TyG (HR, 1.97; 95% CI, 1.30-2.98; P = 0.001) and IBI (HR per 10-units, 1.02; 95% CI, 1.00-1.05; P = 0.022) remained independent predictors of MACE, with the highest risk in those with both markers elevated.
CONCLUSION: TyG and IBI were independently associated with AMR-defined CMD and 12-month MACE after STEMI. Adding TyG and IBI to conventional clinical and procedural factors improved model discrimination for CMD, although prospective multicenter validation is required before clinical application.