scholarly journals Visceral Adiposity Index Plays an Important Role in Prognostic Prediction in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome and Type 2 Diabetes Mellitus Undergoing Percutaneous Coronary Intervention

2021 ◽  
Vol 8 ◽  
Author(s):  
Qi Zhao ◽  
Yu-Jing Cheng ◽  
Ying-Kai Xu ◽  
Zi-Wei Zhao ◽  
Chi Liu ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Primary Endpoint ◽  
Coronary Intervention ◽  
Visceral Adiposity Index ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Percutaneous Coronary

Background: Visceral adiposity index (VAI), a surrogate marker of adiposity and insulin resistance, has been demonstrated to be significantly related to cardiovascular disease. It remains indistinct whether VAI predicts adverse prognosis after percutaneous coronary intervention (PCI) for patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and type 2 diabetes mellitus (T2DM).Methods: A total of 798 participants who met the enrollment criteria were finally brought into this study. VAI was determined by waist circumference, body mass index, fasting triglyceride, and high-density lipoprotein cholesterol as previously reported. Adverse prognosis included all-cause death, non-fatal myocardial infarction, non-fatal ischemic stroke, and ischemia-driven revascularization, the composite of which was defined as the primary endpoint.Results: Higher VAI maintained as a significant and independent risk predictor for the primary endpoint, regardless of the adjustment for the various multivariate models [hazard ratio (95% CI) for fully adjusted model: 2.72 (2.02–3.68), p < 0.001]. The predictive value of VAI was further confirmed in sensitivity analysis where VAI was taken as a continuous variate. There was a dose-response relationship of VAI with the risk of the primary endpoint (p for overall association < 0.001). Moreover, the ability of VAI on the prediction of the primary endpoint was consistent between subgroups stratified by potential confounding factors (all p for interaction > 0.05). VAI exhibited a significant incremental effect on risk stratification for the primary endpoint beyond existing risk scores, expressed as increased Harrell's C-index, significant continuous net reclassification improvement, and significant integrated discrimination improvement.Conclusion: VAI is a significant indicator for predicting worse prognosis and plays an important role in risk stratification among patients with NSTE-ACS and T2DM undergoing elective PCI. The present findings require further large-scale, prospective studies to confirm.

scholarly journals Prognostic impact of atherogenic index of plasma (AIP) in type 2 diabetes mellitus patients with acute coronary syndrome undergoing percutaneous coronary intervention

2020 ◽  
Author(s):  
Xiaoteng Ma ◽  
Yan Sun ◽  
Yujing Cheng ◽  
Hua Shen ◽  
Fei Gao ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Percutaneous Coronary Intervention ◽  
Primary Endpoint ◽  
Coronary Intervention ◽  
Atherogenic Index ◽  
Atherogenic Index Of Plasma ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Abstract Background: The association of atherogenic index of plasma (AIP), an emerging lipid index which can predict risk for cardiovascular (CV) disease, with adverse outcomes in type 2 diabetes mellitus (T2DM) patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) has been undetermined. Therefore, the aim of this study was to investigate whether AIP could independently predict adverse CV events in T2DM patients with ACS undergoing PCI.Methods: This study was a retrospective analysis of a single-centre prospective registry involving 826 consecutive T2DM patients who underwent primary or elective PCI for ACS at our CV center from June 2016 to November 2017. This study eventually included 798 patients (age, 61±10 years, male, 72.7%). AIP was calculated as the base 10 logarithm of the ratio of plasma concentration of triglycerides to high density lipoprotein-cholesterol (HDL-C). All patients were divided into 4 groups based on the AIP quartiles. The primary endpoint was a composite of all-cause death, non-fatal ischemic stroke, non-fatal myocardial infarction (MI), or unplanned repeat revascularization. The key secondary endpoint was a composite of cardiovascular death, non-fatal ischemic stroke, or non-fatal MI.Results: During a median follow-up period of 927 days, 198 patients developed at least one event. An unadjusted Kaplan–Meier analysis showed the incidence of the primary endpoint increased gradually with rising AIP quartiles (log-rank test, P =0.001). A multivariate Cox proportional hazards analysis revealed that compared with the lowest AIP quartile, the top AIP quartile was associated with significantly increased risk for the primary and key secondary endpoints (hazard ratio [HR]: 2.153; 95% confidence interval [CI]: 1.355 to 3.421; P =0.001, and HR: 2.613; 95% CI: 1.024 to 6.666; P =0.044, respectively). Inclusion of AIP quartiles in a baseline prediction model for the primary endpoint increased the Harrell’s C statistic from 0.697 to 0.707. More importantly, addition of AIP quartiles to the above model significantly improved the continuous net reclassification improvement (continuous NRI =19.1%, P <0.001).Conclusions: A higher AIP value on admission was independently and strongly associated with adverse CV events in T2DM patients with ACS undergoing PCI.

scholarly journals Prognostic impact of atherogenic index of plasma (AIP) in type 2 diabetes mellitus patients with acute coronary syndrome undergoing percutaneous coronary intervention

2020 ◽  
Author(s):  
Xiaoteng Ma ◽  
Yan Sun ◽  
Yujing Cheng ◽  
Hua Shen ◽  
Fei Gao ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Percutaneous Coronary Intervention ◽  
Primary Endpoint ◽  
Coronary Intervention ◽  
Atherogenic Index ◽  
Atherogenic Index Of Plasma ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Abstract Background and purposesThe association of atherogenic index of plasma (AIP), an emerging lipid index which can predict risk for cardiovascular (CV) disease, with adverse outcomes in type 2 diabetes mellitus (T2DM) patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) has been undetermined. Therefore, the aim of this study was to investigate whether AIP could independently predict adverse CV events in T2DM patients with ACS undergoing PCI.MethodsThis study was a retrospective analysis of a single centre prospective registry involving 826 consecutive T2DM patients who underwent coronary angiography for ACS and were treated with primary or elective PCI at our CV center from June 2016 to November 2017. This study eventually included 798 patients (age, 61 ± 10 years, male, 72.7%). AIP was calculated as the base 10 logarithm of the ratio of plasma concentration of triglycerides to high density lipoprotein-cholesterol (HDL-C). All patients were divided into 4 groups based on the AIP quartiles. The primary endpoint was a composite of all-cause death, non-fatal ischemic stroke, non-fatal myocardial infarction (MI), or unplanned repeat revascularization. The key secondary endpoint was a composite of cardiovascular death, non-fatal ischemic stroke, or non-fatal MI.ResultsDuring a median follow-up period of 927 days, 198 patients developed at least one event. Unadjusted Kaplan–Meier analysis showed the incidence of the primary endpoint increased gradually with rising AIP quartiles (log-rank test, P = 0.001). Adjusted multivariate Cox proportional hazards analyses revealed that compared with the lowest AIP quartile, the top AIP quartile was associated with significantly increased risk for the primary and key secondary endpoints (hazard ratio [HR]: 2.153; 95% confidence interval [CI]: 1.355 to 3.421; P = 0.001, and HR: 2.613; 95% CI: 1.024 to 6.666; P = 0.044, respectively). Inclusion of AIP quartiles in a baseline prediction model for the primary endpoint increased the Harrell’s C statistic from 0.697 to 0.707. More importantly, addition of AIP quartiles to the above model significantly improved the continuous net reclassification improvement (continuous NRI = 19.1%, P < 0.001).ConclusionA higher AIP value on admission was independently and strongly associated with adverse CV events in T2DM patients with ACS undergoing PCI.

scholarly journals Prognostic Impact of Atherogenic Index of Plasma (AIP) In Type 2 Diabetes Mellitus Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

2020 ◽  
Author(s):  
Xiaoteng Ma ◽  
Yan Sun ◽  
Yujing Cheng ◽  
Hua Shen ◽  
Fei Gao ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Percutaneous Coronary Intervention ◽  
Primary Endpoint ◽  
Coronary Intervention ◽  
Atherogenic Index ◽  
Atherogenic Index Of Plasma ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Abstract Background: The association of atherogenic index of plasma (AIP), an emerging lipid index which can predict risk for cardiovascular (CV) disease, with adverse outcomes in type 2 diabetes mellitus (T2DM) patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) has been undetermined. Therefore, the aim of this study was to investigate whether AIP could independently predict adverse CV events in T2DM patients with ACS undergoing PCI.Methods: This study was a retrospective analysis of a single-centre prospective registry involving 826 consecutive T2DM patients who underwent primary or elective PCI for ACS at our CV center from June 2016 to November 2017. This study eventually included 798 patients (age, 61±10 years, male, 72.7%). AIP was calculated as the base 10 logarithm of the ratio of plasma concentration of triglycerides to high density lipoprotein-cholesterol (HDL-C). All patients were divided into 4 groups based on the AIP quartiles. The primary endpoint was a composite of all-cause death, non-fatal ischemic stroke, non-fatal myocardial infarction (MI), or unplanned repeat revascularization. The key secondary endpoint was a composite of cardiovascular death, non-fatal ischemic stroke, or non-fatal MI.Results: During a median follow-up period of 927 days, 198 patients developed at least one event. An unadjusted Kaplan–Meier analysis showed the incidence of the primary endpoint increased gradually with rising AIP quartiles (log-rank test, P =0.001). A multivariate Cox proportional hazards analysis revealed that compared with the lowest AIP quartile, the top AIP quartile was associated with significantly increased risk for the primary and key secondary endpoints (hazard ratio [HR]: 2.153; 95% confidence interval [CI]: 1.355 to 3.421; P =0.001, and HR: 2.613; 95% CI: 1.024 to 6.666; P =0.044, respectively). Inclusion of AIP quartiles in a baseline prediction model for the primary endpoint increased the Harrell’s C statistic from 0.697 to 0.707. More importantly, addition of AIP quartiles to the above model significantly improved the continuous net reclassification improvement (continuous NRI =19.1%, P <0.001).Conclusions: A higher AIP value on admission was independently and strongly associated with adverse CV events in T2DM patients with ACS undergoing PCI.

scholarly journals Prognostic impact of the atherogenic index of plasma in type 2 diabetes mellitus patients with acute coronary syndrome undergoing percutaneous coronary intervention

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Xiaoteng Ma ◽  
Yan Sun ◽  
Yujing Cheng ◽  
Hua Shen ◽  
Fei Gao ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Percutaneous Coronary Intervention ◽  
Cardiovascular Events ◽  
Coronary Intervention ◽  
Atherogenic Index ◽  
Atherogenic Index Of Plasma ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Abstract Background The association of the atherogenic index of plasma (AIP), an emerging lipid index that can predict the risk for cardiovascular disease, with adverse outcomes in type 2 diabetes mellitus (T2DM) patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) has not been determined. Therefore, the aim of this study was to investigate whether the AIP could independently predict adverse cardiovascular events in T2DM patients with ACS undergoing PCI. Methods This study was a retrospective analysis of a single-centre prospective registry involving 826 consecutive T2DM patients who underwent primary or elective PCI for ACS from June 2016 to November 2017. This study ultimately included 798 patients (age, 61 ± 10 years; male, 72.7%). The AIP was calculated as the base 10 logarithm of the ratio of the plasma concentration of triglycerides to high-density lipoprotein-cholesterol (HDL-C). All the patients were divided into 4 groups based on the AIP quartiles. The primary endpoint was a composite of death from any cause, non-fatal spontaneous myocardial infarction (MI), non-fatal ischaemic stroke, and unplanned repeat revascularization. The key secondary endpoint was a composite of cardiovascular death, non-fatal MI, and non-fatal ischaemic stroke. Results During a median follow-up period of 927 days, 198 patients developed at least one event. An unadjusted Kaplan-Meier analysis showed that the incidence of the primary endpoint increased gradually with rising AIP quartiles (log-rank test, P = 0.001). A multivariate Cox proportional hazards analysis revealed that compared with the lowest AIP quartile, the top AIP quartile was associated with significantly increased risk for the primary and key secondary endpoints (hazard ratio [HR]: 2.249, 95% confidence interval [CI]: 1.438 to 3.517, P < 0.001; and HR: 2.571, 95% CI: 1.027 to 6.440, P = 0.044, respectively). Conclusions A higher AIP value on admission was independently and strongly associated with adverse cardiovascular events in T2DM patients with ACS undergoing PCI.

scholarly journals Comparison of various insulin resistance surrogates on prognostic prediction and stratification following percutaneous coronary intervention in patients with and without type 2 diabetes mellitus

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Qi Zhao ◽  
Yu-Jing Cheng ◽  
Ying-Kai Xu ◽  
Zi-Wei Zhao ◽  
Chi Liu ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Coronary Intervention ◽  
Visceral Adiposity Index ◽  
Baseline Model ◽  
Tyg Index ◽  
Percutaneous Coronary ◽  
Prognostic Prediction

Abstract Background Insulin resistance (IR), evaluation of which is difficult and complex, is closely associated with cardiovascular disease. Recently, various IR surrogates have been proposed and proved to be highly correlated with IR assessed by the gold standard. It remains indistinct whether different IR surrogates perform equivalently on prognostic prediction and stratification following percutaneous coronary intervention (PCI) in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients with and without type 2 diabetes mellitus (T2DM). Methods The present study recruited patients who were diagnosed with NSTE-ACS and successfully underwent PCI. IR surrogates evaluated in the current study included triglyceride-glucose (TyG) index, visceral adiposity index, Chinese visceral adiposity index, lipid accumulation product, and triglyceride-to-high density lipoprotein cholesterol ratio, calculations of which were conformed to previous studies. The observational endpoint was defined as the major adverse cardiovascular and cerebrovascular events (MACCE), including cardiac death, non-fatal myocardial infarction, and non-fatal ischemic stroke. Results 2107 patients (60.02 ± 9.03 years, 28.0% female) were ultimately enrolled in the present study. A total of 187 (8.9%) MACCEs were documented during the 24-month follow-up. Despite regarding the lower median as reference [hazard ratio (HR) 3.805, 95% confidence interval (CI) 2.581–5.608, P < 0.001] or evaluating 1 normalized unit increase (HR 1.847, 95% CI 1.564–2.181, P < 0.001), the TyG index remained the strongest risk predictor for MACCE, independent of confounding factors. The TyG index showed the most powerful diagnostic value for MACCE with the highest area under the receiver operating characteristic curve of 0.715. The addition of the TyG index, compared with other IR surrogates, exhibited the maximum enhancement on risk stratification for MACCE on the basis of a baseline model (Harrell’s C-index: 0.708 for baseline model vs. 0.758 for baseline model + TyG index, P < 0.001; continuous net reclassification improvement: 0.255, P < 0.001; integrated discrimination improvement: 0.033, P < 0.001). The results were consistent in subgroup analysis where similar analyses were performed in patients with and without T2DM, respectively. Conclusion The TyG index, which is most strongly associated with the risk of MACCE, can be served as the most valuable IR surrogate for risk prediction and stratification in NSTE-ACS patients receiving PCI, with and without T2DM.

scholarly journals Prognostic factors in patients with non-ST-segment elevation acute coronary syndrome concurrent with type 2 diabetes mellitus (according to the results of the registry)

2017 ◽  
Vol 89 (3) ◽  
pp. 65-71 ◽  
Author(s):  
A P Golikov ◽  
S A Berns ◽  
R I Stryuk ◽  
E A Shmidt ◽  
A A Golikova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Mortality Rates ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
One Year

Aim. To investigate factors that influence annual prognosis in patients with non-ST-segment elevation acute coronary syndrome ((NSTEACS) concurrent with type 2 diabetes mellitus (DM2). Subjects and methods. The registry of patients with NSTEACS (non-ST-segment elevation myocardial infarction (NSTEMI), unstable angina) included 415 patients, of them 335 had no carbohydrate metabolic disorders, 80 had DM2. The follow-up period, during which the prognosis was evaluated in the patients, was one year after hospital discharge following the index NSTEACS event. Lipidogram readings and the serum levels of endothelin-1 (ET-1), sP-selectin, sE-selectin, and sPECAM were determined on day 10 after admission to hospital. All the patients underwent coronary angiography (CA), Doppler ultrasound of peripheral arteries during their hospital stay. Results. The patients with DM2 versus those without diabetes proved to be significantly older and to have a higher body mass index; among them there were more women, they were noted to have more frequently hypertension and less frequently smoked. The presence of DM2 was associated with significantly increased intima-media thickness and higher GRACE scores (p=0.013) as compared to those in the patients with normal carbohydrate metabolism. There were significant differences in high-density lipoprotein levels that were lower, as well as in triglyceride levels and atherogenic index, which were higher in patients with DM2 than in those without this condition. In addition, there were significant differences in ET-1, sP-selectin, sE-selectin, and sPECAM levels that were significantly higher in the DM2 group. Moreover, the levels of ET-1 and sPECAM were above normal in both the DM and non-DM2 groups. Assessment of poor outcomes at one year of the observation established that cardiovascular mortality rates were significantly higher and coronary angiography was performed much less frequently in the DM2 group. The most significant prognostic factors associated with a poor prognosis were as follows: multifocal atherosclerosis, reduced left ventricular ejection fraction (LVEF) less than 51%, and increased ET-1 levels more than 0.87 fmol/ml. Conclusion. The register-based study has shown that the presence of DM2 statistically significantly increases cardiovascular mortality rates during a year after the index ACS event; the patients of this category are less commonly referred for CA for the estimation of the degree of coronary bed lesion. The most important factors of recurrent cardiovascular events in patients with DM2 within a year after prior ACS are multifocal atherosclerosis, reduced myocardial contractility (LVEF less than 51%), and increased vasospastic endothelial function (an increase in ET-1 levels more than 0.87 fmol/ml).

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