Prognostic impacts of lipoxin A4 in relation to diabetes and insulin resistance in patients with acute myocardial infarction: a prospective study.

AIMS: To investigate whether the prognostic impact of lipoxin A4 (LXA4) is affected by diabetes mellitus (DM) and insulin resistance (IR), as indicated by the triglyceride-glucose index (TyG). MATERIALS AND METHODS: A total of 1569 consecutive patients with acute myocardial infarction (AMI) were prospectively recruited between March 2017 and January 2020. Plasma LXA4 levels were determined using enzyme-linked immunosorbent assay. Patients were stratified into four groups according to DM and TyG (high vs. low). The primary outcome was major adverse cardiovascular event (MACE), a composite of all-cause death, recurrent MI, ischemic stroke, and ischemia-driven revascularizations. RESULTS: High levels of LXA4 (≥ 5.637 ng/mL) were associated lower risk of MACE (hazard ratio [HR]: 0.42, 95% confidence interval [CI]: 0.28-0.65, P < 0.001) in non-DM patients with low TyG (< 5.461) after multiple adjustments, which was not observed in patients with DM or high TyG (P interaction = 0.044). The risk reduction of MACE was mainly driven by fewer recurrent MI (HR, 0.21; 95% CI: 0.08-0.59; P = 0.003) and ischemia-driven revascularizations (HR: 0.45, 95% CI :0.25-0.80, P = 0.007). CONCLUSION: In patients with AMI, ischemic risk reduction associated with high LXA4 levels is attenuated by DM and IR.