Impact of Triglyceride-Glucose Index on Cardiovascular Outcomes in Patients Presented With MINOCA

Acute myocardial infarction (AMI) remains the leading causes of high morbidity and mortality worldwide . Recently, a distinct population with myocardial infarction with nonobstructive coronary arteries (MINOCA) has been increasingly recognized because of the widespread use of coronary angiography. MINOCA occurs in 5%-10% of all AMI and they are younger and more often women compared to patients with AMI and obstructive coronary artery disease (CAD). The underlying causes of MINOCA are manifold and may include plaque rupture or erosion, thromboembolism, coronary spasm, spontaneous dissection, microvascular dysfunction and supply/demand mismatch. Some non-ischemic diseases such as myocarditis may also mimic the presentation of MINOCA . Of note, several studies have found that the prognosis of MINOCA is not trivial and patients are still at considerable risks for long-term adverse cardiovascular (CV) events despite the optimal secondary prevention treatments . Thus, it is of necessity and profound implications to find potential residual risk factors and improve prognosis in MINOCA population.

Insulin resistance (IR), a critical mechanism of the pathogenesis of diabetes, not only contributes to the development of cardiovascular diseases (CVD), but also significantly correlates with adverse CV outcomes. Additionally, IR often coexists with obesity, hypertension, and dyslipidemia , and all of these are well-known risk factors of CVD. Recently, the triglyceride-glucose (TyG) index derived from fasting triglyceride (TG) and fasting blood glucose (FBG) levels has been proposed as a new and valid surrogate indicator of IR . Till now, many studies have found that the TyG index is positively correlated with metabolic disorders, arterial stiffness , carotid atherogenesis , coronary artery calcification , and subclinical or symptomatic CAD. Moreover, growing evidence has showed that the TyG index is an independent predictor of poor CV outcomes in general population and in different cohorts with CAD, including patients with AMI or acute coronary syndrome (ACS) with or without diabetes

Inclusion criteria

• All patients; diagnosed with myocardial infarction with nonobstructive coronary arteries (MINOCA)
• clinical symptoms
• ECG : ischemic changes with or without ST segment elevation
• Echocardiograpy : segmental wall motion abnormalities (SWMA)
• positive cardiac enzymes
• Coronary angiography: insignificant lesions ,the absence of culprit obstructive coronary artery disease (epicardial coronary artery stenosis ≥50%)

Exclusion criteria

• All non confirmed diagnosis of MINOCA
• cardiac

• non-ischemic cardiomyopathies
• non-cardiac

• pulmonary embolism
• stroke
• sepsis
• ARDS