Synergistic effects of insulin resistance and revascularization completeness on prognosis in patients with coronary artery calcification.

BACKGROUND: The association between percutaneous coronary intervention (PCI) outcomes for moderate-to-severe coronary artery calcification (MSCAC) lesions and long-term clinical outcomes in individuals with varying levels of insulin resistance is not well-defined. This study aims to examine the relationship between MSCAC-PCI outcomes and long-term poor clinical outcomes in individuals with varying insulin resistance statuses. METHODS: This prospective cohort research comprised 4,087 patients who received MSCAC-PCI at Fuwai Hospital from January 2017 to December 2018. Patients were classified according to MSCAC-PCI outcomes: failure (device uncrossable or no change in lesion stenosis severity), suboptimal revascularization (meeting neither the criteria for optimal revascularization nor procedural failure), and optimal revascularization (post-PCI TIMI grade = 3 and residual stenosis < 30%). The insulin resistance status was assessed utilizing the triglyceride-glucose (TyG) index, and patients were classified based on baseline TyG tertiles (tertile 1 [T1]: <8.66; T2: 8.66–9.14; T3: ≥9.14). The primary outcome was the composite of cardiovascular (CV) death and target-vessel myocardial infarction (TVMI). RESULTS: During the median follow-up period of 3 years, 154 (3.77%) patients with primary outcomes were recorded. There were 267 instances of MSCAC-PCI failure, 274 instances of suboptimal revascularization, and 3546 instances of optimal revascularization. Patients who underwent optimal revascularization exhibited markedly reduced risks of CV death/TVMI (adjusted hazard ratio [aHR], 0.53; 95% confidence interval [CI], 0.32–0.87) in comparison to those experiencing MSCAC-PCI failure. No significant difference was observed between patients who got suboptimal revascularization and those with MSCAC-PCI failure. Subgroup analysis indicated that patients in the TyG T3 subgroup have a diminished risk of CV death/TVMI (aHR, 0.45; 95% CI, 0.21–0.97) following optimal revascularization, mostly attributable to a decreased risk of CV death (aHR, 0.29; 95% CI, 0.10–0.78) after optimal revascularization. No substantial variations were observed in PCI outcomes between the TyG T1 and T2 subgroups of patients. CONCLUSIONS: Our findings suggest that optimal revascularization during PCI is associated with improved long-term clinical outcomes in patients with MSCAC, particularly in those with a high level of insulin resistance.