Patients with higher TyG index and hyperuricemia at higher risk of MACE after CABG

The multicenter, retrospective cohort study revealed that in patients undergoing CABG, the TyG (triglyceride-glucose) index interacts synergistically with SUA to increase the MACE (major adverse cardiovascular events) risk in patients undergoing CABG. The study appeared in Cardiovascular Diabetology on 02 May 2023.

Previous studies have shown elevated serum uric acid as a risk factor for cardiovascular disease development. TyG index is a novel surrogate for insulin resistance and has been proven to be an independent predictor for adverse cardiac events. No study, however, has specifically focused on the interaction between the two metabolic risk factors. Therefore, Zhenguo Wu, Qilu Hospital of Shandong University, Jinan, Shandong, China, and colleagues aimed to determine if the SUA and TyG index combination could result in a more accurate prognostic prediction in patients undergoing CABG in a multicenter, retrospective cohort study.

The study included a total of 1225 patients who underwent CABG. The patients were grouped based on the sex-specific criteria of hyperuricemia (HUA) and the cut-off value of the TyG index. The interaction between the TyG index and serum uric acid was estimated using attributable proportion (AP), synergy index (SI), and relative excess risk due to interaction (RERI).

The model performance improvement yielded by including the TyG index and SUA was examined by net reclassification improvement (NRI), C-statistics, and integrated discrimination improvement (IDI). The goodness-of-fit of models was assessed using the χ2 likelihood ratio test, Bayesian information criterion (BIC), and Akaike information criterion (AIC).

The study revealed the following findings:

· During follow-up, 263 patients developed MACE.

· The joint and independent associations of the TyG index and serum uric acid with adverse events were significant.

Patients having higher TyG index and hyperuricemia were at higher risk of MACE.

· The authors found a significant synergistic interaction between the TyG index and SUA [RERI: 1.83; AP: 0.41; SI: 2.13].

· There was a significant improvement in prognostic prediction and model fit [change in C-statistic: 0.038; continuous NRI: 0.336; IDI: 0.031; AIC: 3534.29; BIC: 3616.45) on the addition of the TyG index and SUA.

The study revealed the predictive value of the SUA and the TyG index in patients who underwent CABG.

"Our findings provided novel information on the synergistic interaction between the serum uric acid and TyG index," the researchers wrote. "The SUA and TyG index combination could be proposed as a beneficial prognostic indicator in post-CABG patients."

Reference:

Wu, Z., Cheng, C., Sun, X. et al. The synergistic effect of the triglyceride-glucose index and serum uric acid on the prediction of major adverse cardiovascular events after coronary artery bypass grafting: a multicenter retrospective cohort study. Cardiovasc Diabetol 22, 103 (2023). https://doi.org/10.1186/s12933-023-01838-z