Background
Methods
Study design and literature search
Definitions
Data extraction and quality assessment
Statistical analysis and meta-analysis
Results
Literature search and included studies
Quality assessment
The TyG index and CAD risk
Study | Design | Country | Participants characteristics | Total, n | Mean age, years | Male, n (%) | Diabetes, n (%) | TYGI Analysis | TYGI Cutoff | Variables adjusted in MVA | Outcome OR/HR (95%CI) |
---|---|---|---|---|---|---|---|---|---|---|---|
CAD risk | |||||||||||
da Silva [12] | PC | Brazil | Patients have at least one CVD in the last 10 years | 2330 | 63.2 ± 8.1 | 1358 (58.3) | 1024 (44.0) | Categorized | NR | Age, sex, use of hypoglycemic, antihypertensive, anticoagulant, lipid-lowing agents, carbohydrate and lipids intake, stroke, peripheral artery disease, and the presence of any other stage of the disease | Risk of CAD: Asymptomatic: 0.98 (0.78–1.17) Symptomatic: 1.16 (1.01–1.33) Treated: 1.03 (0.97–1.10) |
Si [13] | RC | China | Asymptomatic patients | 697 | 60 (54, 65) | 333 (47.8) | 121 (17.6) | Categorized | 8.04 | Age, sex, smoking, hypertension, DM, LDL-C | Risk of sub-clinical CAD: 2.007 (1.066, 3.780) |
Liu [14] | RC | China | Postmenopausal women and suspected CAD | 869 | NR | NR | 225 (25.9) | Categorized | 9.432 | Age, T2MD, ischemic stroke, SBP, LVEF | Risk of CAD: 1.876 (1.299–2.710) |
Zhao [15] | CS | China | NAFLD who underwent coronary angiography | 424 | NR | 266 (62.7) | 124 (29.2) | Categorized | 9.22 | Age, sex, hypertension, DM and smoking history | Risk of CAD: 2.519 (1.559–4.069) |
Pan [16] | CS | China | Hypertensive patients without CAD | 1841 | 58.3 ± 14.0 | 999 (54.3) | 480 (26.1) | Categorized and Continuous | 8.88 | Age, sex, DM, smoking, HDL-C, Hs-CPR, Lp(a), E/e’ | Risk of CAD: 2.63 (1.80–3.81) |
Coronary artery calcification and stenosis | |||||||||||
Lee [17] | RC | Korea | Asymptomatic adults with T2DM | 888 | 63.9 ± 9.5 | 523 (58.9) | 888 (100.0) | Continuous | NR | Age, sex, HbA1c, duration of DM, SBP, LDL-C, eGFR, UA, smoking, insulin, oral hypoglycemic agents, antiplatelet agents, antihypertensive medication, and statin | Coronary artery stenosis: 3.19 (1.371–7.424) |
Kim [18] | PC | Korea | Asymptomatic adults | 4319 | NR | NR | NR | Continuous | NR | Age, sex, SBP, BMI, LDL-C, HDL-C, smoking, alcohol, and exercise habits | Coronary artery calcification: 1.95 (1.23–3.11) |
Thai [19] | CS | France | T2DM | 166 | 58.9 ± 10.8 | 103 (62.0) | 166 (100) | Continuous | 10 | Duration of DM of 4 years, BMI, eGFR, practicing physical activity, smoking, HbA1c of 7.9% and SBP of 140 mmHg, and logHOMA-IR | Degree of coronary stenosis: 50–69%: 6.89 (1.80–26.44) ≥ 70%: 4.04 (1.00–16.34) |
Ding [20] | CS | China | Asymptomatic, non-diabetic patients undergoing maintenance hemodialysis | 151 | 56.66 ± 12.43 | 84 (55.6) | 0 (0) | Continuous | 8.82 | NR | Coronary artery calcification: 1.281(1.121–1.465) |
Coronary plaque | |||||||||||
Park [21] | RC | Korea | Asymptomatic adults | 1175 | 51 ± 7 | 835 (71.1) | NR | Continuous | NR | Age, sex, BMI, SBP, LDL-C, HDL-C, exercise, alcohol, smoking, presence of DM and hypertension, use of statins and aspirin, and baseline ln(CACS + 1) | Coronary artery calcification progression: 1.82 (1.20–2.77) |
Won [22] | PC | Multi-international | Patients underwent CCTA | 1143 | 60.7 ± 9.3 | 624 (54.6) | 319 (27.9) | Continuous | 9.03 | Age, sex, SBP, BMI, and HDL-C | Coronary plaque progression: 1.083 (1.021–1.150) |
Park [23] | RC | Korea | Asymptomatic adults | 1250 | 52.8 ± 6.5 | 586 (46.9) | 0 (0) | Continuous | 8.48 | Age, sex, SBP, DBP, BMI, LDL-C, HDL-C, and UA | Calcified plaque: 1.488 (0.965–2.295) Non-calcified plaque: 1.581 (1.002–2.493) Mixed plaque: 2.419 (1.051–5.569) |
Wang [24] | RC | China | Nondiabetic patients | 2719 | 60.9 ± 6.6 | 1278 (47.0) | 0 (0) | Continuous | 9 | Age, sex, smoking, alcohol, BMI, eGFR, LDL-C, history of TIA, stroke, CAD, hypertension, dyslipidemia, antihypertensive agents and antiplatelet agents | Presence of coronary plaque: 1.42 (1.14–1.24) |
Multi-vessel coronary artery disease | |||||||||||
Thai [19] | CS | France | T2DM | 166 | 58.9 ± 10.8 | 103 (62.0) | 166 (100) | Continuous | 10 | Duration of DM of 4 years, BMI, eGFR, practicing physical activity, smoking, HbA1c of 7.9% and SBP of 140 mmHg, and logHOMA-IR | Number of vessels with stenosis: 1: 6.88 (1.94–24.38) 2 or 3: 2.74 (0.64–11.76) |
Su [25] | RC | China | CAD patients | 731 | 63 (58–68) | 429 (58.7) | 373 (51.0) | Continuous | 7.77 | Age, sex, SBP, DBP, BMI, smoking, alcohol, antihypertensive agents, antilipidemic agents, and antiplatelet agents | Multi-vessel coronary artery disease: 2.280 (1.530–3.398) |
Wang [26] | RC | China | CAD patients | 2792 | 66 ± 10 | 1927 (69.0) | 1224 (43.8) | Categorized | 7.12 | Age, sex, BMI, smoking, drinking, hypertension, eGFR, antiplatelet drug use, antilipidemic drug use, and antihypertensive drug use | Multi-vessel coronary artery disease: 1.496 (1.183–1.893) |
Xiong [27] | RC | China | ACS patients | 1007 | 66.55 ± 11.41 | NR | NR | Continuous | 9.18 | Age, BMI, hypertension, DM, HR, BNP and SCr | Complexity of CAD: 3.732 (2.330–5.975) |
In-stent re-stenosis after drug-eluting stent | |||||||||||
Zhu [28] | RC | China | ACS patients underwent success PCI | 1574 | 58.4 ± 9.4 | 1218 (77.4) | 544 (34.6) | Continuous | 9.11 | Age, sex, BMI, LVEF, Hs-CRP, hypertension, DM previous PCI, SYNTAX score, target vessel in LAD, target vessel in RCA, the application of intracoronary imagine; DES-sirolimus; stent length, and minimal stent diameter | 1.634 (1.125–2.374) |
Guo [29] | RC | China | CCS | 1414 | 58.04 ± 0.25 | 1103 (78) | NR | Continuous | 8.6 | Age, sex, BMI, previous PCI, presence of PAD, presence of multivessel CAD, Hs-CRP, eGFR, presence of lesion’s length ≥ 20 mm, stent length | 1.73 (1.250–2.417) |
The TyG index and CAD severity
The TyG index and CAD prognosis
Study | Design | Country | Participants characteristics | Total, n | Mean age, years | Male, n (%) | Diabetes, n (%) | TYGI analysis | TYGI Cutoff | Variables adjusted in MVA | Outcome OR/HR (95%CI) | Follow-up duration (months) |
---|---|---|---|---|---|---|---|---|---|---|---|---|
ACS | ||||||||||||
Mao [30] | CS | China | NSTE-ACS | 791 | 62.5 (53.0–68.0) | 295 (67.4) | 143 (32.6) | Categorized | 8.805 | Age, sex, metabolic syndrome, LDL-C, HDL-C, SYNTAX score, CRP, basal insulin, sulfonylurea, metformin, α-glucosidase inhibitor, ACEI/ARB, beta-blocker, and PCI/CABG | ①③④⑥⑦ | 12 |
Luo [31] | RC | China | STEMI underwent PCI | 1092 | NR | 874 (80.0) | 270 (24.7) | Categorized | NR | Age, sex, BMI, SBP, DBP, HR, Killip class > 1, smoking, hypertension, DM, anemia, previous AMI. Atrial fibrillation, BNP, cardiac troponin I, hs-CRP, WBC, neutrophil ratio, platelet, albumin, HbA1c, FPG, TC, triglycerides, HDL-C, LDL-C, UA, eGFR, GPIIb/IIIa antagonists, anticoagulation, lesion vessels, three-vessel disease, Number of stents, Gensini score, LVEF, aspirin, clopidogrel/ticagrelor, statin, beta blockers, ACEI/ARB | ① | 12 |
Hu [32] | RC | China | ACS for PCI | 9285 | 59.9 ± 10.05 | 6996 (75.3) | 4074 (43.9) | Categorized | NR | Age, sex, BMI, smoking, hypertension, previous MI, previous stroke, previous PCI, previous CABG, ACS status; non-HDL-C, lipidlowering and antidiabetes agents | ① | 12 |
Ma [33] | PC | China | T2DM and ACS for PCI | 776 | 61 ± 10 | 560 (72.2) | 776 (100) | Categorized | 9.29 | Age, sex, BMI, DBP, HDL-C, HbA1c, smoking, alcohol, presence of PAD, CKD, cardiac failure, previous MI, past PCI, use of insulin and/or oral antidiabetic agents at discharge, CAD severity, presence of lesions > 20 mm long, use of DCB, and complete revascularization | ① | 30 |
Zhang [34] | RC | China | ACS for PCI | 3181 | NR | 1409 (75.7) | 1231 (38.7) | Categorized | 8.88 | Age, sex, DM, hypertension, previous AMI, hemoglobin, albumin, eGFR, TGs, LVEF, multi-vessel/LM | ①②③④⑤⑥ | 33.3 |
Zhao [35] | RC | China | T2DM and NSTE-ACS for PCI | 798 | 60.9 ± 8.3 | 545 (68.3) | 798 (100) | Categorized and Continuous | 9.18 | Age, sex (female), BMI, SBP, DBP, smoking, drinking, duration of DM, dyslipidemia, prior MI, PCI, stroke and PVD, diagnosis (NSTEMI), TC, HDL-C, eGFR, HbA1c, LVEF, SYNTAX score, LM treatment, DCB use, complete revascularization and number of stents, DAPT at discharge, DAPT interruption in 12 months, statins at discharge, statins interruption in 12 months, oral hypoglycemic agents (metformin, alpha-glucosidase inhibitor, sulfonylurea, dipeptidyl peptidase 4 inhibitor) at discharge and insulin at discharge | ①②④⑥ | 36 |
Wang [36] | RC | China | DM and ACS for PCI | 2531 | 66.3 ± 6.8 | 1415 (55.9) | 2531 (100) | Categorized and Continuous | 9.323 | age, male, smoker, previous MI, previous CABG, BMI, AMI, LVEF, left main disease, multi-vessel disease, HbA1c, hs-CRP, statin, insulin | ①②⑥⑦ | 36 |
Zhao [37] | RC | China | NSTE-ACS for PCI without diabetes | 1510 | 59.7 ± 9.3 | 1113 (73.7) | 0 (0) | Categorized and Continuous | NR | Age, sex, BMI, smoking history, hypertension, dyslipidemia, previous history of MI, PCl, stroke and PAD, NSTE-ACS type, TC, HDL-C, eGFR, HbA1c, LVEF, LM disease, three-vessel disease, CTO, diffuse lesion, in-stent restenosis, SYNTAX score, treatment of LM, LCX, RCA, DES implantation, DCB application, complete revascularization, and number of stents, DAPT at admission, statins at admission, and ACEI/ARB at discharge | ①②④⑥⑦ | 49 |
Zhang [38] | RC | China | ACS for PCI without diabetes | 1655 | NR | 1223 (73.9) | 0 (0) | Categorized | 8.33 | Age, sex,BMI, SBP, hemoglobin, albumin, Scr, HbAlc, TC, LDL-C, HDL-C, history of smoking and stroke, previous medication history including beta-blocker and statins, and statins treatment during hospitalization | ①②③④⑤⑥⑦ | 35.6 |
Jiao [39] | RC | China | ACS for PCI over 80 | 662 | 81.87 ± 2.14 | 476 (71.9) | 231 (34.9) | Categorized and Continuous | NR | Age, sex, BMI, SBP, DBP, LVEF, Gensini score, hypertension, DM, hyperlipidemia, previous MI, previous stroke, CKD, smoking, TC, LDL-C, HDL-C, eGFR, UA, aspirin, clopidogrel, statin, β-blocker, ACEI/ARB, LM lesion, multivessel lesion and treatment | ①② | 63 |
Karadeniz [40] | RC | Turkey | ACS for PCI | 1694 | 64.0 ± 14.4 | 1191 (70.3) | 489 (28.9) | Categorized | 9.3/9.2 | Age, neutrophil, lymphocyte, CRP | ① | 60 |
Guo [41] | RC | China | ACS with prediabetes for PCI | 2300 | 58.87 ± 10.27 | 1505 (74.1) | 0 (0) | Categorized and Continuous | 8.83 | Age, sex, BMI, SBP, DBP, smoking, hypertension, hyperlipemia, LDL-C. HDL-C, Scr, eGFR, BNP, CRP | ①③④⑥⑦ | 18 |
Qin [42] | RC | China | T2DM and ACS for PCI | 899 | NR | NR | 899 (100) | Categorized | NR | Duration of DM, TG, FBG, SCr, WBC, neutrophil, fibrinogen, LVEF, GRACE score | ① | 23 |
Pang [43] | RC | China | NSTE-ACS for PCI | 515 | 62.3 ± 10.1 | 361 (70.1) | 189 (36.7) | Categorized | NR | LVEF, GRACE score, multivessel disease, previous PCI | ① | 24 |
Shen [44] | RC | China | DM and ACS | 231 | 81.58 ± 1.93 | 156 (67.5) | 231 (100) | Categorized | NR | Age, sex, BMI, SBP, DBP, LVEF, Gensini score, hypertension, hyperlipidemia, previous MI, previous stroke, CKD, current smoking, TC, LDL-C, HDL-C, eGFR, UA, aspirin, clopidogrel, statin, β-blocker, ACEI/ARB, LM lesion, multivessel lesion and treatment | ② | 49 |
CCS and stable CAD | ||||||||||||
Jin [45] | CC | China | T2DM and CAD | 800 | NR | 560 (70.0) | 800 (100) | Categorized and Continuous | 9.16 | Age, sex, BMI, hypertension, family history of CAD, smoke, HDL-C, non-HDL-C, SCr, UA, hsCRP and Gensini score | ① | 36 |
Jin [46] | CC | China | T2DM and CAD | 1740 | NR | 1254 (72.1) | 468 (37.3) | Continuous | 9.17 | BMI, LVEF, hypertension, DM, UA, smoking, hsCRP, HDL-C and LDL-C | ① | 36 |
Neglia [47] | RC | Italy | CCS | 1097 | 72 (64–77) | 821 (75.0) | 430 (39.0) | Categorized | 9.22 | Sex, previous MI and/or coronary revascularization, LDL-C, obstructive CAD, SSS > 7 and Hs-CRP | ②③⑥ | |
Yang [48] | PC | China | CCS without diabetes | 5489 | NR | NR | 0 (0) | Continuous | 8.92 | NR | ① | 29 |
Chen [49] | RC | China | CAD and DM underwent OPCABG | 1578 | 62.9 ± 8.0 | 1116 (70.7) | 1578 (100) | Categorized and Continuous | NR | Age, sex, BMI, current smoking, hypertension, previous MI, previous stroke, past PCI, cardiac failure, CKD, preoperative LVEF, insulin dependence, LDL-c, HDL-C, diagnosis, extent of CAD, left main disease, complete revascularization, and use of IABP | ①②⑥⑦ | 24 |
Guo [29] | RC | China | CCS | 1414 | 58.04 ± 0.25 | 1103 (78.0) | NR | Continuous | 8.83 | Age, sex, BMI, previous PCI, presence of PAD, presence of multivessel CAD, Hs-CRP, eGFR, presence of lesion’s length ≥ 20 mm, stent length | ④ | 60 |
Lin [50] | RC | China | CTO with T2DM | 681 | 59.16 ± 9.82 | 563 (82.7) | 681 (100) | Categorized | 9.02 | Age, BMI, SBP, previous MI, previous PCI, TC, LDL-C, TG, FPG, eGFR, UA, isulin | ①④⑥ | 22 |
MINOCA | ||||||||||||
Gao [51] | PC | China | MINOCA | 1179 | NR | NR | NR | Continuous | 8.99 | Age, sex, MI type, hypertension, DM and dyslipidemia | ① | 41.7 |