What does this research mean for the field?

CTI is an independent predictor of 1-year major adverse cardiovascular events (MACE), primarily driven by acute heart failure events, in STEMI patients undergoing primary percutaneous coronary intervention. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

May 26, 2026Frontiers in Cardiovascular Medicine0 citationsOpen Access

Prognostic value of CTI for major adverse cardiovascular events in patients With ST-elevation myocardial infarction after primary percutaneous coronary intervention

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: ST-elevation myocardial infarction (n=618). Intervention: C-reactive protein-triglyceride glucose index (CTI). Primary outcome: 1-year major adverse cardiovascular events (MACE) (HR 1.443, 95% CI 1.191-1.748, p=<0.001).

QZQiang ZhaoShanghai Jiao Tong University SFShenwen FuJinhua Central Hospital XHXiaokang HuUniversity Hospital Münster

Key Result

Elevated C-reactive protein-triglyceride glucose index (CTI) was independently associated with an increased risk of 1-year major adverse cardiovascular events (HR 1.443) in STEMI patients after PCI.

Study Design

Type

Cohort (n=618)

Multicenter

Structured PICO

Does CTI predict 1-year MACE in STEMI patients undergoing primary PCI?

Population

618 patients with ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI)

Outcome

1-year major adverse cardiovascular events (MACE)composite

CTI is an independent predictor of 1-year MACE, primarily driven by acute heart failure events, in STEMI patients after primary PCI.

Main Result

Effect estimate: HR 1.443 (95% CI 1.191-1.748)

p-value: p=<0.001

Limitations

Single-center retrospective study design may limit generalizability and introduce selection bias
Potential residual confounding from unmeasured factors such as medication adherence and lifestyle variables
Some variables, including alcohol consumption, were not quantified in detail
Missing data, particularly for LVEF, were handled using multiple imputation
Modest improvement in discrimination and clinical net benefit after adding CTI to the baseline model
Observational design precludes establishing causal inference

Abstract

Methods A total of 618 STEMI patients who underwent PCI were retrospectively enrolled. The primary endpoint was 1-year MACE. Feature selection was performed using the Boruta algorithm. Multivariable Cox regression analysis was conducted to evaluate the independent association between CTI and MACE. The incremental prognostic information provided by CTI was assessed using 365-day time-dependent receiver operating characteristic (ROC) curves and the DeLong test, while clinical utility was evaluated using decision curve analysis (DCA). Subgroup analysis was performed according to diabetes status. Sensitivity analyses using different adjustment strategies were conducted to assess the robustness of the results. Results During follow-up, 139 patients (22.5%) experienced MACE. CTI was identified as an important predictor by the Boruta algorithm and remained independently associated with MACE in multivariable Cox regression analysis (HR = 1.443, 95% CI: 1.191–1.748, P 0.001). Although the addition of CTI to the baseline model resulted in only modest improvement in discrimination and clinical net benefit, further component analysis showed that the association between CTI and MACE was mainly driven by acute heart failure events. Subgroup analysis demonstrated consistent associations between CTI and MACE regardless of diabetes status ( P for interaction = 0.504). The association between CTI and MACE remained robust across multiple sensitivity analyses. Conclusions CTI was an independent predictor of MACE in STEMI patients undergoing PCI. Notably, the association appeared to be mainly driven by acute heart failure events, suggesting a close relationship between CTI and post-infarction ventricular dysfunction.

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