Insulin resistance as a predictor of long-term adverse cardiovascular event risk in patients with atrial fibrillation following radiofrequency catheter ablation.

Authors

Hanxiong Liu, Junli Pan, Yan Luo, Yan Tang, Dongyue Jia, Jie Feng, Yuqi Tao, Sisi Wang, Shiqiang Xiong, Wei Huang

Published in

Frontiers in endocrinology. Volume 17. Pages 1831673. Epub Jul 02, 2026.

Abstract

Catheter ablation is the first-line therapy for atrial fibrillation (AF), yet a significant proportion of patients experience major adverse cardiovascular events (MACEs) post-ablation, highlighting a need for improved risk stratification.
This study aimed to evaluate the association between four non-insulin-based insulin resistance (IR) indices and long-term MACEs in AF patients undergoing radiofrequency catheter ablation (RFCA), and to determine their incremental predictive value beyond established clinical risk factors.
A retrospective observational study was conducted on 922 non-valvular AF patients who underwent index RFCA between March 2017 and July 2023. The primary endpoint was a composite of MACEs, defined as all-cause death, late AF recurrence, heart failure events, and stroke occurring after the 3-month blanking period. Associations between the four IR indices and MACEs were examined using multivariable Cox proportional hazards regression, restricted cubic spline analysis, and Kaplan-Meier survival estimation. The incremental predictive value of each index over a baseline clinical model was quantified using the C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).
Over a median follow-up of 36 months, MACEs occurred in 242 patients (26.25%). After full multivariable adjustment, METS-IR and TyG-BMI were independently and significantly associated with elevated MACE risk across all models (both P < 0.001), while the TG/HDL-C ratio and TyG index did not reach statistical significance in fully adjusted models. METS-IR demonstrated an approximately linear dose-response relationship with MACEs on restricted cubic spline analysis. When added to the baseline clinical model (C-statistic: 0.702), METS-IR conferred the greatest incremental predictive gain, significantly improving the C-statistic to 0.717 (P < 0.001), alongside meaningful NRI (0.291, 95% CI: 0.126-0.426, P < 0.001) and IDI (0.015, 95% CI: 0.004-0.035, P = 0.004).
Among the evaluated non-insulin-based IR indices, METS-IR demonstrated a statistically significant, albeit modest, incremental improvement in the prediction of composite MACE in AF patients following RFCA. These findings support the use of METS-IR in post-ablation risk assessment and may contribute to improved patient outcomes.

PMID:
42466343
Bibliographic data and abstract were imported from PubMed on 17 Jul 2026.

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