The Prognostic Value Of TyG Index Combined With NLR In Non-diabetic ACS Patients Treated With Drug-eluting Stents

Objective:To explore the prognostic value of triglyceride glucose index（Ty G index）and neutrophil lymphocyte ratio（NLR）in patients with non-diabetic acute coronary syndrome（ACS）treated with drug-eluting stent（DES）alone or jointly.Methods:Retrospective inclusion of non-diabetic ACS patients who underwent coronary angiography and received DES treatment in our hospital from October 2019 to October 2021.According to the inclusion and exclusion criteria,a total of 377 patients were enrolled,including 303 males and 74females.From the morning after admission,the patient took fasting venous blood and sent it to the laboratory of our hospital for testing total cholesterol（TC）,triglyceride（TG）,low density lipoprotein cholesterol（LDL-C）,high density lipoprotein cholesterol（HDL-C）,fasting venous blood glucose（FBG）,blood creatinine（CR）,blood uric acid（UA）,brain natriuretic peptide（BNP）and blood cell count.General clinical data,left ventricular ejection fraction（LVEF）,coronary angiography and interventional treatment information were collected;Ty G index,NLR,residual lipoprotein cholesterol（RLP-C）,non-high-density lipoprotein cholesterol（non-HDL-C）and Gensini score were calculated.Follow up patients were followed for the occurrence of major adverse cardiovascular events（MACE）including all-cause death,nonfatal myocardial infarction,ischemic stroke,angina requiring hospitalization,unplanned revascularization.Patients were divided into MACE group（n=50）and non MACE group（n=27）according to whether MACE occurred during the follow-up period.SPSS 25.0 was used to analyze the general clinical data characteristics between the two groups.Also,enrolled patients were further divided into low Ty G index group（Ty G index≤8.58mg/dl）and high Ty G index group（Ty G index>8.58mg/dl）based on the median Ty G index values,and the characteristics of patients’general clinical data and occurrence of MACE were compared between the two groups.And Kaplan Meier curves were drawn.And the Cox proportional hazards model was used to analyze the risk factors of mace in non-diabetic ACS patients after DES treatment using MACE events as the endpoint.Receiver operating characteristic（ROC）curves were used to assess the diagnostic efficacy of the Ty G index,NLR,and the combination of both on outcomes of nondiabetic ACS patients treated with DES.Results:1.According to whether MACE occurred or not during the follow-up period,the patients were divided into MACE group（50 cases）and non-MACE group（327 cases）.There were no significant difference between the two groups in sex,smoking history,proportion of hypertension history,age,LDL-C,HDL-C,LY,FBG,CR,UA levels（P>0.05）.There were significant difference in BMI,TC,TG,NEUT,Ty G index,NLR,RLP-C,non-HDLC,BNP level and Gensini score.These targets in the MACE event group were higher than those in the non-MACE group.And the proportion of LVEF and single-vessel lesion patients was lower than that in the non-MACE group,the difference was statistically significant（P<0.05）.2.The patients were further divided into low Ty G index group（Ty G index≤8.58mg/d L）and high Ty G index group（Ty G index>8.58mg/d L）according to the median of Ty G index.There were no significant differences between the two groups in gender,smoking history and hypertension history,as well as the levels of HDL-C,NEUT,BNP,CR and NLR,LVEF,Gensini score and the number of coronary artery lesions.Compared with the low Ty G index group,the high Ty G index group had a lower age,higher levels of BMI,TC,TG,LDL-C,LY,FBG,UA,RLP,non-HDLC and higher incidence of MACE,with statistical significance（P<0.05）.Further Kaplan Meier curves showed that patients with high Ty G index had a significantly higher incidence of mace than those with low Ty G index（log rank:P<0.001）.3.With the occurrence of MACE as the endpoint index,the single factor BMI,TC,TG,NEUT,LVEF,RLP,non HDL-C,BNP,Gensini score,Ty G index and NLR were included in the Cox risk model.The analysis of the multi-factor Cox risk model showed that:,after adjusting for risk factors,Ty G index（HR:3.345,P<0.001,95%CI:1.894-5.907）,NLR（HR:1.146,P<0.001,95%CI:1.062-1.238）and Gensini score（HR:1.010,P=0.004,95%CI:1.003-1.016）was still an independent risk factor for MACE.4.ROC curve results showed that the area under the curve（AUC）of Ty G index and NLR were:AUC_{Ty G index}:0.716,95%CI_{Ty G index}:0.634-0.798;AUC _NLRwas 0.626,95%CI_NLR:0.530-0.721.The best cut-off value of Ty G index was 8.65,with a sensitivity of 70%and a specificity of 59%for predicting MACE.When the optimal cut-off value of NLR was 3.22,the sensitivity and specificity of predicting MACE were 66%and 55%,respectively.Ty G index combined with NLR had the largest area under the ROC curve（0.798,95%CI:0.727-0.868）,with a sensitivity of 70%and a specificity of 80%for predicting MACE.Delong test showed that the combined variable of Ty G index and NLR could more effectively predict the risk of recurrent MACE in non-diabetic ACS patients after DES(Z_{Ty G index-}associated variable=2.058,PTy G index-associated variable=0.039;ZNLR-associated variable=2.786,PNLR-associated variable=0.005).Conclusions:1.Ty G index and NLR are independent risk factors for MACE in non-diabetic ACS patients after DES treatment.With the increase of Ty G index,the risk of MACE in non-diabetic ACS patients increases.2.When Ty G index>8.65 or NLR>3.22,the incidence of MACE in non-diabetic ACS patients increased.3.Ty G index combined with NLR is more effective than single index in predicting the risk of recurrent MACE in non-diabetic ACS patients after DES.