{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T03:21:15Z","timestamp":1787800875478,"version":"build-2784847793"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 &amp;lt; 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 &amp;lt; 0.001), alongside meaningful NRI (0.291, 95% CI: 0.126\u20130.426, P &amp;lt; 0.001) and IDI (0.015, 95% CI: 0.004\u20130.035, P\u00a0=\u00a00.004).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1831673","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T04:25:23Z","timestamp":1782966323000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Insulin resistance as a predictor of long-term adverse cardiovascular event risk in patients with atrial fibrillation following radiofrequency catheter ablation"],"prefix":"10.3389","volume":"17","author":[{"given":"Hanxiong","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]},{"name":"Department of Cardiology, The Third People's Hospital of Chengdu, (Affiliated Hospital of Southwest Jiaotong University), College of Medicine, Southwest Jiaotong University","place":["Chengdu, Sichuan, China"]},{"name":"Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junli","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Third People's Hospital of Chengdu, (Affiliated Hospital of Southwest Jiaotong University), College of Medicine, Southwest Jiaotong University","place":["Chengdu, Sichuan, China"]},{"name":"Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongyue","family":"Jia","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuqi","family":"Tao","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sisi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research 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