Clinical trial NCT06066177: Impact of Triglyceride-Glucose Index on Cardiovascular Outcomes in Patients Presented With MINOCA
Official title: Impact of Triglyceride-Glucose Index on Cardiovascular Outcomes in Patients Presented With Myocardial Infarction With Nonobstructive Coronary Arteries
Study type: OBSERVATIONAL
Overall status: NOT_YET_RECRUITING
Conditions: Major Cardiovascular Events
Keywords: Triglyceride glucose index Myocardial infarction MINOCA
Lead sponsor: Assiut University
Sponsor class: OTHER
First posted: 2023-10-04
Enrollment: 100
Sex: ALL
Maximum age (years): 80
Standard ages: CHILD
ADULT
OLDER_ADULT
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Myocardial infarction patients who were underwent PPCI and the coronary angiography showing insignificant lesions (stenosis less than 50% )

Brief summary: This work was designed to explore the role of the triglyceride-glucose (TyG) index in the prediction of cardiovascular outcomes in Patients Presented with myocardial infarction with nonobstructive coronary arteries.

Detailed description: 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

Eligibility criteria: 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

Primary outcomes:
measure: Incidence of major adverse cardiovascular events (MACE)
timeFrame: along one year follow up .
Secondary outcomes:
Other outcomes:
Locations:
Study officials:
affiliation: Cardiology department
name: Ayman khairy Mohamed Hassan
role: PRINCIPAL_INVESTIGATOR
affiliation: Cardiology department
name: Khaled Mohamed Abdullah Mohamed
role: PRINCIPAL_INVESTIGATOR
References:
citation: Gao S, Ma W, Huang S, Lin X, Yu M. Impact of triglyceride-glucose index on long-term cardiovascular outcomes in patients with myocardial infarction with nonobstructive coronary arteries. Nutr Metab Cardiovasc Dis. 2021 Oct 28;31(11):3184-3192. doi: 10.1016/j.numecd.2021.07.027. Epub 2021 Aug 4.
citation: Zhao X, Wang Y, Chen R, Li J, Zhou J, Liu C, Zhou P, Sheng Z, Chen Y, Song L, Zhao H, Yan H. Triglyceride glucose index combined with plaque characteristics as a novel biomarker for cardiovascular outcomes after percutaneous coronary intervention in ST-elevated myocardial infarction patients: an intravascular optical coherence tomography study. Cardiovasc Diabetol. 2021 Jun 28;20(1):131. doi: 10.1186/s12933-021-01321-7.