背景：胰岛素抵抗和炎症在冠状动脉粥样硬化发生和进展的机制中存在相互作用。然而，其与慢性冠状动脉综合征（Chronic coronary syndrome, CCS）患者发生再次血运重建事件的相关性仍不确定。本研究旨在探讨甘油三酯-葡萄糖-C反应蛋白（Triglyceride-glucose-C-reactive protein, TyG-CRP）指数在接受经皮冠状动脉介入（Percutaneous coronary intervention, PCI）治疗术后的CCS患者中预测再次血运重建事件的价值。

方法：本研究连续纳入2016年6月至2017年10月于阜外医院就诊的接受PCI治疗术后的CCS患者共2255名。TyG-CRP指数计算公式为Ln（空腹甘油三酯（mg/dL）×空腹血糖（mg/dL）/2）×超敏C反应蛋白（Hypersensitive C-reactive protein, hs-CRP）（mg/L）；并根据TyG-CRP指数的三分位数进行分组，分为T1，T2以及T3。研究终点为患者发生再次血运重建事件。采用限制性立方样条以及多因素Cox比例风险回归分析评估TyG-CRP指数与研究终点之间的相关性。

结果：在中位随访61.23个月的过程中，976名（43.28%）患者发生至少一次再次血运重建事件。校正混杂因素后，TyG-CRP指数与CCS患者发生再次血运重建事件的风险独立相关（风险比 [Hazard ratio, HR]：1.003，95%置信区间 [Confidence interval, CI]：1.002-1.005）。此外，以T1作为参考，在T2和T3组中的患者发生再次血运重建事件的风险分别增加了22.9%（HR：1.229，95% CI：1.049-1.441）与24.0%（HR：1.240，95% CI：1.060-1.451），且趋势分析具有统计学差异（P for trend < 0.05）。此外，TyG-CRP指数与再次血运重建风险之间存在线性的剂量反应关系（P for nonlinear = 0.132，P overall < 0.05）。亚组分析显示TyG-CRP指数对再次血运重建事件风险的影响在所有预先指定的亚组中保持稳健（P for interaction > 0.05）。

结论：本研究表明，TyG-CRP指数可以成为评估接受PCI治疗术后的CCS患者预后的独立预测因子。TyG-CRP指数升高与再次血运重建风险升高相关。

Background: Insulin resistance and inflammation are interrelated in the pathogenesis of coronary atherosclerosis development and progression. However, its association with repeat revascularization events in patients with chronic coronary syndrome (CCS) remains uncertain. This study aimed to investigate the prognostic value of triglyceride-glucose-C-reactive protein (TyG-CRP) index in predicting repeat revascularization events in CCS patients undergoing percutaneous coronary intervention (PCI).

Methods: A total of 2255 patients who underwent PCI at Fuwai Hospital from June 2016 to October 2017 were consecutively included in this study; the calculation formula of TyG-CRP index was Ln (fasting triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2) × Hypersensitive C-reactive protein (hs-CRP) (mg/L); and based on the tertiles of the TyG-CRP index patients are grouped into T1, T2 and T3. The study endpoint was the incident of repeat revascularization. The association between the TyG-CRP index and the study endpoint was assessed by multivariable Cox proportional hazards regression analysis and restricted cubic splines.

Results: During the median follow-up of 61.23 months, 976 (43.28%) patients experienced at least one repeat revascularization event. After adjusting for potential confounding factors, TyG-CRP index was independently associated with the risk of the study endpoint event in CCS patients (HR: 1.003, 95% CI: 1.002-1.005; P < 0.0001). In addition, using T1 as the reference, the risk of patients in the T2 and T3 groups increased by 22.9% (HR: 1.229, 95% CI: 1.049-1.441; P = 0.011) and 24.0% (HR: 1.240, 95% CI: 1.060-1.451; P = 0.007), and the trend analysis is statistically significant (P for trend < 0.05). Moreover, there was a linear and dose-response relationship between TyG-CRP index and the study endpoint (P for nonlinear = 0.132, P overall < 0.05). And subgroup analysis showed that the effect size of the TyG-CRP index on the study endpoint remained robust across all prespecified subgroups (P for interaction > 0.05).

Conclusion: This study shows that TyG-CRP index can be an independent predictor for evaluating the prognosis of CCS patients undergoing PCI. Elevated TyG-CRP index is associated with an increased risk of repeat revascularization.