Publicação
Triglyceride-Glucose Index as a Predictor of Cardiovascular Outcomes in Acute Coronary Syndrome Patients
| Resumo: | Abstract Introduction: Cardiovascular diseases (CVD), particularly acute coronary syndromes (ACS), remain a leading cause of morbidity and mortality worldwide. Insulin resistance (IR) has emerged as a pivotal but underrecognized contributor to cardiovascular risk. The triglyceride-glucose (TyG) index is a simple and validated surrogate marker of IR and has shown promise in predicting adverse cardiovascular outcomes. However, its prognostic role in ACS remains underexplored. This study aimed to assess the impact of the TyG index on cardiovascular outcomes in patients admitted with ACS who underwent percutaneous coronary intervention (PCI). We further evaluated whether combining the TyG index with the GRACE score improves risk stratification and prognostic accuracy. Methods: We conducted a retrospective, single-centre, observational study including 534 adult patients admitted with ACS between January 2019 and December 2023. Patients were stratified into low and high TyG index groups (cut-off: 8.80) and low and high GRACE score groups (cut-off: 109). Demographic, clinical, laboratory, and angiographic data were collected. The primary endpoint was the incidence of major adverse cardio-vascular and cerebrovascular events (MACCE) at 12 months, including myocardial infarction (AMI), stroke, revascularization, and death. Kaplan-Meier survival analyses were performed. Results: High TyG index patients were significantly younger and had higher rates of diabetes, dyslipidaemia, obesity, and chronic kidney disease. Despite no significant differences in coronary anatomy or initial ACS presentation, metabolic markers were markedly worse in the high TyG group. TyG index alone was not associated with MACCE incidence but predicted AMI-free survival significantly better than the GRACE score (p=0.046 vs p=0.068). Combining TyG index and GRACE score revealed a statistically significant stratification for both MACCE-free and AMI-free survival (p<0.0001 and p=0.030, respectively). Conclusion: The TyG index is an accessible and cost-effective tool that reflects IR and cardiometabolic burden. While not predictive of short-term MACCE alone, it enhances AMI risk stratification, particularly when combined with the GRACE score. These findings suggest that integrating metabolic markers like the TyG index into routine ACS risk models may improve long-term cardiovascular risk prediction. |
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| Autores principais: | Sousa,Rita Noversa de |
| Outros Autores: | Lima,Andreia Sá; Lobo,Mariana Campos; Sousa,Sara de; Viana,Susana; Gil,João Caiano |
| Assunto: | Acute Coronary Syndrome Biomarkers Triglycerides. |
| Ano: | 2025 |
| País: | Portugal |
| Tipo de documento: | artigo |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Fundação para a Ciência e Tecnologia |
| Idioma: | inglês |
| Origem: | SciELO Portugal |
| Resumo: | Abstract Introduction: Cardiovascular diseases (CVD), particularly acute coronary syndromes (ACS), remain a leading cause of morbidity and mortality worldwide. Insulin resistance (IR) has emerged as a pivotal but underrecognized contributor to cardiovascular risk. The triglyceride-glucose (TyG) index is a simple and validated surrogate marker of IR and has shown promise in predicting adverse cardiovascular outcomes. However, its prognostic role in ACS remains underexplored. This study aimed to assess the impact of the TyG index on cardiovascular outcomes in patients admitted with ACS who underwent percutaneous coronary intervention (PCI). We further evaluated whether combining the TyG index with the GRACE score improves risk stratification and prognostic accuracy. Methods: We conducted a retrospective, single-centre, observational study including 534 adult patients admitted with ACS between January 2019 and December 2023. Patients were stratified into low and high TyG index groups (cut-off: 8.80) and low and high GRACE score groups (cut-off: 109). Demographic, clinical, laboratory, and angiographic data were collected. The primary endpoint was the incidence of major adverse cardio-vascular and cerebrovascular events (MACCE) at 12 months, including myocardial infarction (AMI), stroke, revascularization, and death. Kaplan-Meier survival analyses were performed. Results: High TyG index patients were significantly younger and had higher rates of diabetes, dyslipidaemia, obesity, and chronic kidney disease. Despite no significant differences in coronary anatomy or initial ACS presentation, metabolic markers were markedly worse in the high TyG group. TyG index alone was not associated with MACCE incidence but predicted AMI-free survival significantly better than the GRACE score (p=0.046 vs p=0.068). Combining TyG index and GRACE score revealed a statistically significant stratification for both MACCE-free and AMI-free survival (p<0.0001 and p=0.030, respectively). Conclusion: The TyG index is an accessible and cost-effective tool that reflects IR and cardiometabolic burden. While not predictive of short-term MACCE alone, it enhances AMI risk stratification, particularly when combined with the GRACE score. These findings suggest that integrating metabolic markers like the TyG index into routine ACS risk models may improve long-term cardiovascular risk prediction. |
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