Title : Inflammatory and insulin resistance indicators for predicting repeat revascularization and in-stent restenosis in patients with chronic coronary syndrome undergoing percutaneous coronary intervention
Abstract:
Objective The C-Reactive protein-triglyceride glucose index (CTI) serves as a dependable proxy for both inflammatory status and insulin resistance, demonstrating an independent association with various clinical presentations of coronary artery disease. This research sought to assess the prognostic significance of the CTI index in forecasting repeat revascularization and in-stent restenosis (ISR) among patients with chronic coronary syndrome (CCS) treated with percutaneous coronary intervention (PCI).
Methods A total of 2147 participants were enrolled and stratified into groups based on CTI tertiles. The primary endpoint was defined as a composite of PCI-related complications, including repeat revascularization and ISR. Log-rank tests and Kaplan-Meier methods were performed to explore differences in event rates between CTI tertiles and plot time-to-event curves. The association of the CTI index with the primary endpoint was examined using multivariable Cox proportional hazards regression analysis via restricted cubic splines (RCS). The predictive performance of the models was evaluated using receiver operating characteristic (ROC) curves, with the area under curve (AUC) metric quantifying the model’s discriminative ability. The value of the CTI was defined as the Ln (fasting triglycerides (mg/dL)×fasting plasma glucose (mg/dL)/2) + 0.412 × ln [CRP (mg/L)].
Results During a median follow-up period of 60 months, a total of 992 patients (46.20%) experienced at least one primary endpoint event. The incidence of the primary endpoint during follow-up exhibited a graded increase across tertiles of the CTI index. Multivariable adjustment confirmed the CTI index as an independent risk factor for the primary endpoint among patients with CCS (HR, 1.11; 95% CI 1.01-1.22; P=0.03). Moreover, when using the lowest tertile as reference, the highest CTI tertile conferred a 1.30-fold increased risk for the primary endpoint (HR, 1.30; 95% CI 1.10-1.54; P=0.002). Furthermore, the CTI index demonstrated a linear, dose-response pattern in its association with the primary endpoint (non-linear P=0.174, P overall=0.042). CTI index, age, gender, BMI, diabetes, hypertension, previous PCI, previous MI, Lp(a), HDL-C, presence of multivessel CAD, presence of lesion length≥20 mm, number of stents, and stent length can be used as independent variables to construct a clinical prediction model. The ROC analysis demonstrated that this multivariate prediction model had limited predictive accuracy for the primary endpoint, with area-under-the-curve estimates of 0.63 (95%CI 0.60-0.65) at 3 years and 0.65 (95%CI 0.62-0.67) at 5 years.
Conclusions The CTI index is independently linked to an elevated risk for repeat revascularization and ISR in the long-term follow-up of CCS patients after PCI. This study highlights its potential utility as a potent prognostic indicator in CCS patients after PCI.
Keywords C-reactive protein-triglyceride-glucose index, Percutaneous coronary intervention, Repeat revascularization, In-stent restenosis
