Triglyceride to high-density lipoprotein cholesterol ratio associated with long-term adverse clinical outcomes in patients deferred revascularization following fractional flow reserve

Abstract

Abstract Background Deferred revascularization following fractional flow reserve (FFR) for coronary intermediate lesions is highly recommended by guidelines. The effect of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) on cardiovascular diseases is also well studied. However, the relationship between TG/HDL-C and long-term clinical adverse outcomes remains unknown for patients deferred revascularization following FFR. Methods We retrospectively included 374 coronary artery disease (CAD) patients with non-significant coronary lesions diagnosed by coronary angiography (CAG) and FFR. All patients were categorized into three subgroups in terms of TG/HDL-C tertiles. The primary endpoint was the composite of major adverse cardiovascular and cerebrovascular events (MACCEs). A Cox regression model was utilized to reveal the association between TG/HDL-C and prevalence of MACCEs. Results 47 MACCEs were documented over a median follow-up period of 6.6 years. The Kaplan-Meier survival curves showed a higher MACCEs rate occurred in the higher TG/HDL-C group (5.6% vs. 12.9% vs. 19.4%, log-rank p < 0.01). After adjustment, patients in T3 suffered a 2.6-fold risk compared to the T1 group (T3 vs. T1: HR 2.55, 95% CI 1.05–6.21, p = 0.038; T2 vs. T1: HR 1.71, 95% CI 0.65–4.49, p = 0.075; p for trend = 0.001). The restricted cubic spline (RCS) analysis illustrated that the HR for MACCEs increased with increasing TG/HDL-C. Both the receiver operating characteristic (ROC) and time-dependent ROC proved the excellent predictive power of TG/HDL-C. Conclusion The present study demonstrates that TG/HDL-C is associated with MACCEs risk and suggests that TG/HDL-C is a reliable predictor of long-term cardiovascular events in CAD patients deferred revascularization following FFR.