Predictive value of combined Triglyceride glucose index and stress hyperglycemia ratio for adverse prognosis in elderly patients with coronary artery disease after percutaneous coronary intervention

Background

Triglyceride-glucose (TyG) index and stress hyperglycemia ratio (SHR) are novel metabolic biomarkers in coronary heart disease, both of which have shown certain value in risk stratification and prognosis evaluation. However, the prognostic value of their combination in predicting adverse outcomes in the special population of elderly patients aged≥65 years with coronary artery disease(CAD) undergoing percutaneous coronary intervention (PCI) has not been fully investigated.

Purpose

This study,based on a cohort of elderly patients aged≥65 years with CAD undergoing PCI,aims to explore the clinical value of the combination of TyG index and SHR in predicting adverse prognosis in this high-risk population.

Methods

This retrospective study enrolled 1202 CAD elderly patients aged≥65 years undergoing PCI from December 2017 to January 2024. Patients were divided into 4 groups (G1 to G4) based on the median TyG index (T1: TyG<8.87; T2: TyG≥8.87) and median SHR index (Q1: SHR<0.84; Q2: SHR≥0.84). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs) at the 12-month follow-up, which included all-cause death, non-fatal myocardial infarction, unplanned repeat revascularization, and stroke. Cox proportional hazards model, Kaplan-Meier analysis, and subgroup analysis were employed to access associations between the combined TyG index and SHR with MACCEs.A nomogram was developed using multivariable logistic regression models, incorporating SHR, TyG index, and variables identified by the least absolute shrinkage and selection operator (LASSO) regression. SHapley Additive exPlanations (SHAP) analysis was applied to further elucidate the predictive performance of each individual factor.

Result

The cohort had a median age of 75.1±5.5 years(69.6–80.6 years), with 62.4% male (750/1202). Fully adjusted Cox proportional hazards model demonstrated that, compared with the reference group (TyG<8.72 and SHR<0.84), patients with both TyG≥8.72 and SHR≥0.84 had the highest risk of MACCEs (HR 2.66, 95% CI 1.66–4.27,p<0.001). Restricted cubic spline (RCS) analysis confirmed a linear positive correlation between the TyG index and MACCEs (P for overall: 0.004, P for non−linearity: 0.118). SHR exhibited a J-shaped relationship with MACCEs (P for overall: 0.019, P for non−linearity: 0.048), with an ideal SHR of 0.84.

Following feature selection via LASSO regression,the key predictors identified and incorporated into the predictive nomogram model, which includes SHR, TyG index, previous PCI,Barthel, hypersensitive C-reactive protein,weight, white blood cell and 7 other variables.SHAP analysis revealed that SHR and TyG index were the most influential predictors.

Conclusion

This study find that the combined assessment of the TyG index and SHR provides a robust basis for prognostic stratification in elderly CAD patients undergoing PCI.RCS analysis of SHR and the TyG indexFor image description, please refer to the figure legend and surrounding text.nomogram & SHAP analysisFor image description, please refer to the figure legend and surrounding text.