The Triglyceride-Glucose Index Stratifies Cardiovascular Risk After PCI: A Cohort Study Identifying the Highest-Risk Patients.
Abstract
Background
The triglyceride-glucose (TyG) index is a surrogate marker of insulin resistance, but its prognostic value across guideline-defined cardiovascular risk strata remains unclear.
Methods
In this retrospective cohort study, 23,592 patients undergoing percutaneous coronary intervention (PCI) were stratified into non-high-risk (VHR0), high-risk (VHR1), and very-high-risk (VHR2) groups based on contemporary atherosclerotic cardiovascular disease criteria. The TyG index was evaluated as continuous and categorical (tertiles) variables. Primary endpoint was a 3-year composite of cardiovascular death, non-fatal myocardial infarction, or stroke (CV events).
Results
During a median follow-up of 3.1 years, elevated TyG was independently associated with increased risks of CV events only in the VHR2 group (adjusted HR 1.51 for T3 vs. T1, 95% CI 1.10-2.08, p = 0.011). In VHR2 patients, adding TyG to a baseline risk model significantly improved reclassification (NRI 0.1251, p = 0.035) and discrimination (IDI 0.0028, p = 0.002). No significant associations were found in VHR0 or VHR1 groups.
Conclusion
The TyG index independently predicts 3-year cardiovascular events specifically in very-high-risk patients after PCI and provides incremental prognostic utility, supporting its use for refined risk stratification and personalized secondary prevention in this high-risk population.