Predictive value of combined TyG-BMI and hsCRP for clinical outcomes in patients with chronic coronary syndrome undergoing PCI: a retrospective cohort study

This retrospective cohort study investigated the joint prognostic value of the triglyceride glucose-body mass index (TyG-BMI) and high-sensitivity C-reactive protein (hsCRP) for post-PCI adverse outcomes in patients with chronic coronary syndromes (CCS) undergoing percutaneous coronary intervention (PCI). A total of 2274 patients were enrolled and categorized into TyG-BMI tertiles (T1-T3), and were further stratified by hsCRP levels (≤ 3 vs. > 3 mg/L). The primary endpoint was a composite of repeat revascularization or in-stent restenosis (ISR). Cox regression, restricted cubic spline, joint stratification, interaction, sensitivity, and time-specific analyses were performed, including an analysis censored at 12 months and a 1-year landmark analysis. Over a median follow-up of 60.5 months, 1054 patients (46.4%) experienced the primary endpoint. Each 100-unit increase in TyG-BMI was associated with a 30.8% higher risk of the composite endpoint (adjusted HR 1.308, 95% CI 1.106–1.546; P = 0.002), with a linear association observed across the TyG-BMI range. Compared with T1, patients in T3 had a significantly higher risk of the composite endpoint (adjusted HR 1.263, 95% CI 1.086–1.468; P = 0.002). In cross-stratified analyses, hsCRP > 3 mg/L was associated with a higher risk only in the T3 group (adjusted HR 1.325, 95% CI 1.082–1.623; P = 0.006). Compared with patients in TyG-BMI T1 and hsCRP ≤ 3 mg/L, those in TyG-BMI T3 and hsCRP > 3 mg/L had a 52.3% higher risk of the composite endpoint (adjusted HR 1.523, 95% CI 1.239–1.872; P < 0.001). No significant multiplicative or additive interaction between TyG-BMI and hsCRP was detected. In time-specific analyses, this combined high-risk subgroup showed a modest association with events within the first year after PCI, whereas in the 1-year landmark analysis it remained at the highest risk of the composite endpoint beyond 1 year (adjusted HR 1.569, 95% CI 1.218–2.021; P < 0.001). Concurrent elevation of TyG-BMI and hsCRP identifies a subgroup of CCS patients at particularly high risk of repeat revascularization or ISR after PCI. Combined assessment of these two markers may provide complementary prognostic information after PCI, particularly for identifying longer-term residual risk.