Key result
Higher TyG index linked to ~53% higher MACE risk in patients with AMI and CKD.
Why the study?
Patients with acute myocardial infarction and chronic kidney disease have a poor prognosis driven by insulin resistance, but the comparative predictive performance of insulin resistance indices for MACE and their incremental value over the GRACE score required evaluation.
Do insulin resistance indices predict major adverse cardiovascular events and enhance the predictive capacity of the GRACE score in patients with acute myocardial infarction and chronic kidney disease?
Cohort (n=1,803)
No
Do insulin resistance indices predict major adverse cardiovascular events and enhance the predictive capacity of the GRACE score in patients with acute myocardial infarction and chronic kidney disease?
Answers are grounded in this paper and cite their sources.
In patients with concurrent AMI and CKD, insulin resistance indices (especially the TyG index) independently predict adverse cardiovascular events and provide modest but significant improvements to the prognostic accuracy of the GRACE score.
BACKGROUND: Patients with both acute myocardial infarction (AMI) and chronic kidney disease (CKD) face a markedly poor prognosis, a key driver of which is insulin resistance (IR). This study aims to systematically evaluate and compare the predictive performance of four commonly used IR indices for major adverse cardiovascular events (MACE), and to assess their incremental value over the GRACE score in this patient group. METHODS: This retrospective cohort study analyzed 1,803 patients with AMI and CKD. Multivariable Cox regression determined associations between IR indices and MACE. Predictive performance was evaluated using C-statistics, continuous net reclassification improvement (cNRI), and integrated discrimination improvement (IDI). The Area Under the Curve (AUCs) for MACE prediction were: TyG index 0.62, AIP 0.57, TyG-BMI 0.58, and METS-IR 0.56. Incorporating IR indices significantly enhanced the GRACE score's predictive capacity, with TyG index providing the greatest incremental improvement (cNRI = 0.137, IDI = 0.03). CONCLUSION: IR indices predict outcomes in patients with AMI and CKD and enhance GRACE score prediction, with TyG index demonstrating superior performance.
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Ni et al. (2026) conducted a cohort in Acute myocardial infarction and chronic kidney disease (n=1,803). Triglyceride-glucose (TyG) index vs. Lower TyG index levels (continuous or lower tertiles) was evaluated on Major adverse cardiovascular events (MACE) (HR 1.53, 95% CI 1.33-1.77, p=<0.001). The Triglyceride-glucose (TyG) index was independently associated with an increased risk of major adverse cardiovascular events (adjusted HR 1.53) in patients with acute myocardial infarction and CKD.
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