Abstract: Background Triglyceride-glucose (TyG) index and triglyceride-glucose-body mass index (TyG-BMI) are considered to be alternative indicators of insulin resistance (IR) and have been shown to be associated with cardiovascular disease. However, evidence regarding their correlations with atherosclerotic plaque characteristics in patients with acute coronary syndrome (ACS) remains limited. Objective This study aimed to investigate the associations of the TyG index and TyG-BMI with vulnerable plaque at the culprit lesion in patients with ACS. Methods A total of 680 patients with ACS who were admitted to Central China Fuwai Hospital of Zhengzhou University from June 2022 to December 2023 were enrolled retrospectively. All patients underwent coronary angiography and optical coherence tomography (OCT) image. According to the diagnostic criteria of thin-cap fibroatheroma (TFCA), patients were divided into non-TCFA group (339 cases) and TCFA group (238 cases). The baseline data coronary angiography results and OCT images were compared. Multivariate Logistic regression was performed to identify factors associated with TCFA. Subgroup analyses were conducted according to glycemic status. The receiver operating characteristic (ROC) of TyG index and TyG-BMI index in the diagnosis of TCFA in different subgroups was analyzed, and the area under the ROC curve (AUC) of the two indexes in each subgroup was calculated to evaluate the diagnostic efficacy. Results The TyG index [9.01 (8.60, 9.50) vs. 8.58 (8.19, 8.92), P<0.001] and TyG-BMI index [239.96 (217.72, 264.50) vs. 218.81 (198.02, 242.60), P<0.001] in the TCFA group were both higher than those in the non-TCFA group. The proportions of macrophage infiltration, plaque rupture, and punctate calcification in the TCFA group were higher than those in the non-TCFA group (P<0.05). After adjusting for confounding factors, the results of multivariate Logistic regression analysis showed that an elevated TyG index (OR=4.216, 95%CI=2.924-6.079, P<0.001) and TyG-BMI index (OR=1.011, 95%CI=1.005-1.016, P<0.001) were risk factors for TCFA occurrence. Patients were divided into diabetic subgroups, prediabetic subgroups, and non-diabetic subgroups based on different glucose metabolic states, with 284 cases, 212 cases, and 81 cases respectively. Subgroup analysis showed that an elevated TyG index was a risk factor for TCFA occurrence in different glucose metabolic states, while an elevated TyG-BMI index was only a risk factor for TCFA occurrence in the diabetic subgroup (P<0.05). The ROC results showed that the AUCs of the TyG index and TyG-BMI index for predicting TCFA occurrence in the diabetic subgroup were 0.729 and 0.660, respectively; in the prediabetic subgroup, they were 0.695 and 0.634, respectively; and in the non-diabetic subgroup, they were 0.697 and 0.629, respectively. Conclusion Both the TyG index and TyG-BMI are associated with the presence of vulnerable plaque in ACS patients. The TyG index demonstrates superior diagnostic value over TyG-BMI for predicting vulnerable coronary atherosclerotic plaques in ACS patients.

Key words: Acute coronary syndrome, Triglyceride-glucose index, Vulnerable plaque, Optical coherence tomography

摘要： 背景 三酰甘油-葡萄糖（TyG）指数、三酰甘油葡萄糖-体质指数（TyG-BMI）被认为是胰岛素抵抗（IR）的替代指标，已被证明与心血管疾病相关，但TyG、TyG-BMI与急性冠脉综合征（ACS）患者动脉粥样硬化斑块相关性的研究尚少。目的 本研究旨在探讨TyG指数及TyG-BMI指数与ACS患者冠状动脉罪犯病变易损斑块的关联。方法 回顾性分析2020年6月—2023年12月就诊于郑州大学华中阜外医院接受冠状动脉造影及光学相干断层成像（OCT）检查的680例ACS患者，并依据是否存在薄纤维帽粥样硬化斑块（TFCA）分为非TCFA组（339例）和TCFA组（238例），对比基线资料、冠脉造影结果及OCT图像。采用多因素Logistic回归分析探究TCFA的影响因素，并进行不同糖代谢状态亚组分析，分析不同亚组中TyG指数、TyG-BMI指数诊断TCFA的受试者工作特征曲线（ROC曲线），并计算各亚组中两者ROC曲线下面积（AUC）评估诊断效能。结果 TCFA组TyG指数［9.01（8.60，9.50）比8.58（8.19，8.92），P<0.001］、TyG-BMI指数［239.96（217.72，264.50）比218.81（198.02，242，60），P<0.001］均高于非TCFA组。TCFA组巨噬细胞浸润、斑块破裂、点状钙化比例高于非TCFA组（P<0.05）。调整混杂因素后，多因素Logistic回归分析结果显示，TyG指数（OR=4.216，95%CI=2.924~6.079，P<0.001）和TyG-BMI指数（OR=1.011，95%CI=1.005~1.016，P<0.001）升高是TCFA发生的危险因素。根据不同糖代谢状态将患者分为糖尿病亚组、糖尿病前期亚组、非糖尿病亚组，分别为284例、212例、81例。亚组分析显示，TyG指数升高在不同糖代谢状态下均为TCFA发生的危险因素，TyG-BMI指数升高仅在糖尿病亚组患者中为TCFA发生的危险因素（P<0.05）。ROC结果显示，糖尿病亚组中TyG指数和TyG-BMI指数预测TCFA发生的AUC分别为0.729和0.660，糖尿病前期亚组中为0.695和0.634，非糖尿病亚组中为0.697和0.629。结论 TyG指数、TyG-BMI指数水平与ACS患者易损斑块的发生相关，TyG指数对预测ACS患者冠状动脉粥样硬化易损斑块发生更具有价值。

关键词: 急性冠脉综合征, 三酰甘油葡萄糖指数, 易损斑块, 光学相干断层成像