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Insulin Sensitivity Score Predicts Post-CABG Risk


Core Concepts
Insulin resistance score predicts post-CABG risk.
Abstract
The study focuses on the relationship between the metabolic score for insulin resistance (METS-IR) and major adverse cardiac events (MACE) in patients following coronary artery bypass graft (CABG) surgery. Key Takeaways Higher METS-IR linked to increased MACE risk post-CABG. METS-IR offers risk stratification independent of traditional factors. First study to explore METS-IR and MACE post-CABG. Study Design Retrospective analysis of 1100 CABG patients in China. METS-IR calculated using fasting glucose, triglycerides, BMI, and HDL. MACE defined as composite outcome including death, MI, PCI, CABG, or stroke. Key Results Patients in highest METS-IR quartile had 97% higher MACE risk. Each SD increase in METS-IR raised MACE risk by 36%. Addition of METS-IR improved MACE prediction post-CABG. Limitations Retrospective nature limits causal inference. Bias possible due to telephone follow-up for MACE rates. Lack of METS-IR measurements at multiple time points.
Stats
Patients in the highest METS-IR quartile had a significant 97% higher risk of MACE during follow-up compared with those in the lowest METS-IR quartile after adjusting for potential confounders. Foreach standard deviation increase in METS-IR score the MACE risk increased by a significant 36% after full adjustment. Adding METS-IR to traditional risk factors for cardiovascular disease significantly improved MACE prediction following CABG surgery, raising the C-statistic for MACE prediction with full adjustment from 0.702 without METS-IR to 0.720 with METS-IR.
Quotes
"CABG is standard treatment for people with multivessel and left main coronary artery disease and significantly improves cardiovascular outcomes, but long-term survival after CABG remains poor." "The results suggest that METS-IR is a simple and reliable measure for risk stratification and to guide early interventions for patients who have undergone CABG surgery."

Key Insights Distilled From

by Marlene Busk... at www.medscape.com 05-10-2023

https://www.medscape.com/viewarticle/991795
Simple Insulin Sensitivity Score Stratifies Post-CABG Risk

Deeper Inquiries

How can the findings on METS-IR and MACE post-CABG impact treatment strategies?

The findings on METS-IR and MACE post-CABG can have significant implications for treatment strategies. By identifying patients with a higher METS-IR score as having a greater risk of MACE after CABG surgery, healthcare providers can tailor their treatment plans accordingly. For instance, patients in the highest quartile for METS-IR could be closely monitored post-surgery, with more aggressive management of cardiovascular risk factors such as blood glucose levels, triglycerides, and cholesterol. Early interventions, such as lifestyle modifications or pharmacological therapies targeting insulin resistance, could be initiated to improve outcomes and reduce the risk of MACE. This personalized approach based on METS-IR scores can lead to better postoperative care and potentially improve long-term survival rates for CABG patients.

What are the potential implications of using METS-IR in risk prediction models beyond CABG patients?

The use of METS-IR in risk prediction models extends beyond CABG patients and can have broader implications in cardiovascular risk assessment. METS-IR, as a simple and reliable measure of insulin resistance, can be incorporated into risk prediction models for various cardiovascular conditions, such as coronary artery disease, heart failure, or stroke. By including METS-IR in these models, healthcare providers can better stratify patients based on their metabolic health and identify individuals at higher risk for adverse cardiovascular events. This proactive approach allows for early interventions and targeted therapies to mitigate the impact of insulin resistance on cardiovascular outcomes. Furthermore, incorporating METS-IR into risk prediction models can enhance the accuracy of risk assessment tools and improve the overall management of cardiovascular diseases beyond the scope of CABG surgery.

How might the study design be improved to address the limitations identified in the research?

To address the limitations identified in the research, several improvements can be made to the study design. Firstly, conducting a prospective study instead of a retrospective analysis would provide stronger evidence and reduce the potential for bias inherent in retrospective studies. Additionally, implementing a more robust follow-up method, such as in-person visits or electronic health records, could improve the accuracy of data collection and minimize recall bias associated with telephone follow-ups. Including multiple measurements of METS-IR at different time points beyond just the baseline assessment would offer a more comprehensive understanding of how changes in insulin resistance impact long-term cardiovascular outcomes post-CABG. By enhancing the study design in these ways, future research can strengthen the validity and reliability of the findings on METS-IR and MACE in patients undergoing CABG surgery.
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