Predictive Value Of SYNTAX Score Ⅱ And Triglyceride Glucose Index For Long-term Prognosis In Patients With Acute ST Segment Elevation Myocardial Infarction With Multivessel Disease

Objective: Triglyceride glucose index(TyG index)has been proved to be a simple and sensitive alternative index of insulin resistance,which has potential predictive ability for early screening,risk stratification and prognosis of patients with cardiovascular disease.The purpose of this study was to investigate the predictive value of SYNTAX score Ⅱcombined with TyG index for adverse cardiovascular events after percutaneous coronary intervention(PCI)in patients with acute ST segment elevation myocardial infarction and multivessel disease.Methods: From January 2014 to January 2020,946 patients with ST segment elevation myocardial infarction complicated with multivessel disease were enrolled in this retrospective cohort study.The general clinical data,laboratory examination results,coronary angiography results and medication were collected.According to the prognosis,they were divided into good prognosis group(n=659)and poor prognosis group(n=287).According to the area under the ROC curve of TyG index,the patients were divided into low TyG index group(TyG<10.04,n=558)and high TyG index group(TyG≥ 10.04,n=388).According to the SYNTAX score Ⅱ International score standard,the patients were divided into low SSII group(0-22,n=490),medium SSII group(23-32,n=371)and high SSII group(≥33,n=85).Multivariate Cox regression model was used to analyze the influencing factors of adverse cardiovascular events.The diagnostic value of SYNTAX score Ⅱ combined with TyG index for adverse cardiovascular events was evaluated by likelihood ratio test,Akaike information criterion(AIC),receiver operating characteristic(ROC)curve,net weight classification improvement(NRI)and comprehensive differentiation improvement(IDI).Results:During the follow-up period of 24 months,with the increase of SYNTAX score Ⅱ and TyG index,the incidence of adverse cardiovascular events increased significantly(P<0.05).The survival time of low TyG index group was longer than that of high TyG index group(P<0.05).Multivariate COX regression analysis showed that SYNTAX scoreⅡ and TyG index were independent risk factors for adverse cardiovascular events in STEMI patients with multivessel disease after PCI(HR=1.616 and 1.165,95%CI:1.201-2.176 and 0.988-1.046,P<0.05).ROC curve analysis showed that SYNTAX score Ⅱ and TyG index had diagnostic value in predicting adverse cardiovascular events in STEMI patients with multivessel disease after PCI.When SYNTAX score Ⅱ and TyG index were combined,the diagnostic efficiency increased: [AUC:(SSII: 0.612 vs.SSII +TyG index: 0.729,P<0.05)].The maximum likelihood estimation method was used to estimate the parameters,and AIC analysis was performed to select the best prediction model.It was concluded that syntax II score combined with TyG index had better fitting,and AIC value was lower(all P<0.001).With the inclusion of TyG index,the net weight classification index and overall differentiation index of SYNTAX score Ⅱ model for diagnosing the risk of adverse cardiovascular events in STEMI patients with multivessel disease were significantly increased(NRI =0.319,P<0.001,P<0.001;IDI=0.034,P<0.001).Conclusion: SYNTAX score Ⅱ and TyG index are independent predictors of long-term adverse cardiovascular events in patients with acute STEMI and multivessel disease after PCI.The combination of TyG index and SYNTAX score Ⅱcan better predict long-term adverse cardiovascular events in patients with acute STEMI and multivessel disease,which is expected to be applied to clinical prognosis evaluation.