The relationship between the triglyceride glucose index and coronary artery stent restenosis in stable coronary artery disease

PURPOSE: Coronary artery disease is one of the most common causes of death in the world. If symptoms of ischemia persist despite medical treatment in patients with considered stable coronary artery disease, stenosis in the epicardial coronary arteries is treated with percutaneous coronary intervention (PCI). The symptomatic benefits of this approach have been demonstrated in many studies; however, the high rate of in-stent restenosis (SIR) remains an unresolved clinical problem in practice. In-stent restenosis is more than 50% stenosis in the previously implanted stent or within 5 mm of the proximal and distal stent edges. The triglyceride glucose (TyG) index is a new marker that has been shown to have a high sensitivity and specificity in detecting metabolic syndrome and insulin resistance. Meta-analyses have proven that metabolic syndrome increases the risk of cardiovascular disease. TyG index is calculated by a formula that includes fasting triglyceride and glucose levels [fasting triglycerides (mg / dl) x fasting glucose (mg / dl) / 2]. This marker has been shown to predict cardiovascular disease (CVD) morbidity and mortality in the general population and in many patient cohorts. However, no data is currently available on the effects of the TyG index on stent restenosis in patients with stable stented coronary artery disease. In our study, we aimed to examine the relationship between the TyG index and stent restenosis in patients with stable coronary artery disease. MATERİAL AND METHOD: Among the patients who underwent angiography due to stable coronary artery disease in Ankara City Hospital Adult Catheter Unit between March 1, 2019 and May 15, 2021, 235 patients with in-stent restenosis (case) and 265 patients without stent restenosis (control) were included in the study. The files of the patients included in the study, e-nabız data, medeczane data were scanned retrospectively, demographic data were obtained, cardiovascular risk factors were evaluated and recorded.Also, the previous coronary angiography and percutaneous coronary intervention reports of the patients were examined, and the lesion characteristics, stents used, and all data related to in-stent restenosis were recorded. The endpoint of our study was to determine the existence of a positive relationship between the TyG index and stent restenosis, and to evaluate the value of the TyG index in predicting stent restenosis and its power in distinguishing the disease. RESULTS: 500 patients with stable coronary artery disease were included in the study. The mean age of these patients was 62.98 ± 9.84 years. The male sex ratio was 72.6%, and the female sex ratio was 27%. The mean Triglyceride values; was 150.5 mg/dl (39-477) in all patients included in the study, 141 mg/dl (40-445) in the non-restenosis group, and 156 mg/dl (39-477) in the restenosis group. A significant difference was found between the two groups (p=0.013). The mean glucose values were 101 mg/dl (47 - 398) in all patients included in the study, 96 mg/dl (47 - 300) in the non-restenosis group, and 111 mg/dl (67 - 398) in the restenosis group. A significant difference was found between the two groups (p=0.001). The average of the calculated TyG index in all patients was 7912.5 (1860 - 79003).The mean TyG index was calculated as 7138 (1860-43845) in the non-restenosis group; and was calculated as 9089 (2106 - 79003) in the restenosis group. A significant difference was found between the two groups (p=0.001). When the effect of TyG index on restenosis was analyzed statistically, AUC was calculated as 0.63 (0.58-0.68). Cut-off value was calculated as 8006, sensitivity as 60% and specificity as 61%. In other words, we expect restenosis with 60% sensitivity and 61% specificity in patients whose TyG index value is calculated above 8006. CONCLUSION: In our study, TyG index was found to be significantly higher in patients with SIR compared to the group without SIR. One of the recent new markers of insulin resistance is the TyG index, and it has been shown in previous studies that insulin resistance is significantly associated with SIR. Our study shows that the TyG index is positively associated with higher stent restenosis, and it may be considered to use the TyG index as a parameter to predict stent restenosis and to make the TyG index a treatment target in stented patients. Large prospective controlled randomized studies are needed to clarify this relationship. KEYWORDS: TyG index, in-stent restenosis, stable coronary artery disease