ArticleCardiovascular drugs and therapy2026
Combined Prognostic Value of Triglyceride-Glucose Index and Bilirubin in Drug-Eluting Stent Restenosis: From Clinical Risk Stratification to Exploratory Vascular-Cell Findings.
Article in Cardiovascular drugs and therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDrug-eluting stent in-stent restenosis (DES-ISR) remains a clinically relevant complication after percutaneous coronary intervention for acute coronary syndrome (ACS). We assessed the combined predictive value of the triglyceride-glucose (TyG) index and total bilirubin (TB), alongside exploratory vascular-cell findings.
methodsThis retrospective cohort included 1,160 ACS patients undergoing drug-eluting stent implantation and angiographic follow-up. Associations with DES-ISR, discrimination, calibration, and incremental prediction were evaluated using multivariable models and split-sample internal validation. HUVECs and VSMCs were exposed to high-glucose/high-triglyceride or bilirubin-related conditions; network pharmacology, reverse docking, and selected pathway experiments were used to generate and evaluate hypotheses.
resultsHigher TyG was associated with increased DES-ISR risk (adjusted OR = 1.487, 95% CI 1.067-2.073), whereas higher TB was associated with lower risk (OR = 0.875, 95% CI 0.838-0.914). The TyG-TB model had AUCs of 0.702 (training) and 0.676 (validation), with Brier score 0.134, calibration slope 0.858, and Hosmer-Lemeshow P = 0.868. Adding TyG and TB improved prediction (ΔAUC = 0.078; continuous NRI = 0.714; IDI = 0.060; all P < 0.001). High-glucose/high-triglyceride exposure was associated with proliferative, oxidative, RAGE/NF-κB/MAPK-related, and insulin-response changes; FPS-ZM1 attenuated selected responses.
conclusionTyG and TB showed opposite associations with DES-ISR and jointly provided moderate incremental predictive information. The cell findings support RAGE-related vascular responses under the tested conditions but require external and mechanistic validation before clinical application.
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