Prognostic value of the atherogenic index of plasma in patients with multivessel coronary disease undergoing CABG: a retrospective cohort study

The Atherogenic Index of Plasma (AIP), a composite lipid index based on triglycerides (TG) and HDL-C, has been linked to cardiovascular risk. However, the prognostic relevance of AIP after coronary artery bypass grafting (CABG) in patients with multivessel coronary disease (MVD) is not well established. Therefore, we examined whether AIP predicts long-term outcomes in our cohort. Consecutive patients with MVD undergoing CABG (2015–2020) were included. The baseline and 1-year AIP were used to define tertiles. Major adverse cardiovascular and cerebrovascular events (MACCEs) were evaluated across AIP groups using Kaplan–Meier methods and Cox regression with multivariable adjustment. Restricted cubic splines (RCS) were used to assess potential non-linear (dose–response) relationships between AIP and MACCEs. In total, 1,602 patients were analysed, and 414 MACCEs occurred during a median follow-up of 43 months. Kaplan–Meier curves showed that group 3 had a significantly lower survival rate than those in the other two groups (P = 0.022). In adjusted Cox models, with group 1 as the reference, the hazard ratios were 1.11 (95% CI 0.86–1.43; P = 0.42) for group 2 and 1.38 (95% CI 1.07–1.78; P = 0.012) for group 3. However, when the AIP at 1 year postoperatively was used as the primary indicator, the differences between groups were no longer statistically significant. Additionally, RCS models suggested a linear correlation between the AIP and MACCE. Incorporation of AIP into traditional models showed a small incremental gain. Preoperative AIP remained an independent predictor of adverse long-term outcomes after CABG among patients with MVD. Optimising AIP through proactive lipid management may help reduce the residual cardiovascular risk and improve long-term prognoses.