Prognostic Impact of Metabolic and Inflammatory Risk for Periprocedural MI and Long-Term Events in Three-Vessel Disease Patients.

Purpose: Risk stratification and management of three-vessel coronary artery disease (3VD) remains challenging. Patients with 3VD tolerate greater metabolic and inflammatory burdens than patients with single- and double-vessel coronary artery disease. This study aimed to evaluate the prognostic value of triglyceride-glucose (TyG) index and high-sensitive C-reactive protein (hsCRP), which representing metabolic and inflammatory burdens respectively in a 3VD cohort. Patients and Methods: This is a retrospective observational study, totally 4495 patients with 3VD were enrolled in the study and divided into 4 groups according to TyG (≥ or <8.5) and hsCRP (≤ or >2mg/L). The primary endpoints were periprocedural myocardial infarction (PMI) following percutaneous coronary intervention (PCI) and major adverse cardiovascular events (MACCEs). Restricted cubic spline (RCS), multivariate Cox proportional hazard models, C-index and net reclassification improvement (NRI) were used for analyses. Results: The median follow-up time was 2.4 years. 3VD patients with TyG≥8.5 and hsCRP>2mg/L exhibited 70%-145% increase risk of PMI according to different definitions. Multivariate Cox regression analyses showed that hsCRP>2mg/L was associated with approximately 30% increased risk of MACCEs in 3VD patients with TyG≥8.5 (HR: 1.31, 95% CI: 1.02-1.69, p = 0.036) and TyG<8.5 (HR: 1.31, 95% CI: 1.02-1.68, p = 0.034) (both p<0.05). RCS analysis regarding hsCRP as continuous variable found increased hsCRP is positively associated with MACCEs among 3VD patients independent of TyG index (all p<0.05). Finally, the NRI for PMI (0.38, p<0.01) and MACCEs (0.16, p<0.01) were also significantly increased after hsCRP and TyG were added to the baseline model. Conclusion: 3VD patients with TyG≥8.5 and hsCRP>2mg/L has significantly increased risks of PMI. HsCRP>2mg/L, alone or in combination of TyG≥8.5, has significantly increased risk of MACCEs among 3VD individuals, highlighting the necessity of managing metabolic and inflammatory burdens simultaneously in 3VD patients.