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.