Combination of TyG Index and GRACE Risk Score as Long-Term Prognostic Marker in Patients with ACS Complicated with T2DM Undergoing PCI

Zhen Qin,1– 3 Shuai Xu,1– 3 Ruixia Yuan,4 Zeyu Wang,1– 3 Yongzheng Lu,1– 3 Yanyan Xu,1– 3 Yan Lv,1– 3 Fengyi Yu,1– 3 Jing Bai,1– 3 Hui Zhang,1– 3 Li Zhang,1– 3 Jinying Zhang,1– 3 Junnan Tang1– 3 1Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, People’s Republic of China; 2Henan Province Key Laboratory of Cardiac Injury and Repair, Zhengzhou, Henan, 450052, People’s Republic of China; 3Henan Province Clinical Research Center for Cardiovascular Diseases, Zhengzhou, Henan, 450018, People’s Republic of China; 4Clinical Big Data Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, People’s Republic of ChinaCorrespondence: Junnan Tang, Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, People’s Republic of China, Tel +86 15890696166, Email fcctangjn@zzu.edu.cn Jinying Zhang, Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, People’s Republic of China, Tel +86 13503830283, Email jyzhang@zzu.edu.cnObjective: We aimed to investigate the prognostic value of the triglyceride-glucose (TyG) index combined the with Global Registry of Acute Coronary Events (GRACE) score in adult acute coronary syndrome (ACS) patients with type 2 diabetes mellitus (T2DM) who underwent percutaneous coronary intervention (PCI).Methods: The study enrolled total 899 ACS patients with T2DM who underwent PCI. TyG index and the GRACE risk score were calculated and assessed by median. The correlation was analyzed by Spearman’s rank correlation coefficient. The cumulative major adverse cardiovascular event (MACE) curve was generated using the Kaplan–Meier method. Multivariate Cox regression was used to identify predictors of MACEs. Additionally, the receiver operating characteristic curve (ROC), net reclassification index (NRI) and Integrated Discrimination Improvement (IDI) were applied to analyze the performance of each single factor index and combined multivariate index in predicting MACE.Results: In the ACS patients with T2DM after PCI, there were significant differences in the TyG index and GRACE risk score between the MACE group and the MACE-free group (P < 0.001). Kaplan–Meier analysis showed that the TyG index combined with the GRACE risk score was positively correlated with the occurrence of MACEs (log rank P < 0.001). Multivariate Cox regression analyses showed that the TyG index, the GRACE risk score, and the TyG index combined with the GRACE risk score were independent predictors of long-term MACEs (adjusted HR: 1.805; 95% CI: 1.479– 2.203, P < 0.001; adjusted HR: 1.012; 95% CI: 1.009– 1.016, P < 0.001; and adjusted HR: 2.337; 95% CI: 1.805– 3.025, P < 0.001, respectively). Correlation analysis indicated that the TyG index was positively correlated with the GRACE risk score (R = 0.140, P < 0.001). The analysis of AUC, NRI and IDI revealed that the combined multivariate index performed better prognostic role than each single factor index in predicting the occurrence of MACE.Conclusion: Both the GRACE risk score and the TyG index could be significant and independent predictors of clinical outcomes in ACS patients with T2DM after PCI. A combination of them could be enhanced predictions of clinical outcomes in these patients.Keywords: triglyceride-glucose index, GRACE risk score, predictive biomarker, acute coronary syndrome, type 2 diabetes mellitus, percutaneous coronary intervention