Relationship between hs-CRP-triglyceride glucose index and coronary plaque morphology: insights from optical coherence tomography

Background Accumulating evidence has underscored that coronary plaque morphology is the key determinant of acute cardiovascular events. The high-sensitivity C-reactive protein-triglyceride-glucose index (CTI) has been shown to correlate strongly with cardiovascular events and mortality. However, no previous study has investigated the relationship between CTI and detailed plaque morphological features evaluated using in vivo optical coherence tomography (OCT). Methods In this retrospective cross-sectional study, 444 patients with coronary artery disease (CAD) who underwent OCT prior to percutaneous coronary intervention (PCI) were analyzed. The association between CTI and plaque morphology was examined employing multivariable logistic regression models. Stratified analyses according to clinical presentation (stable angina pectoris [SAP] vs. acute coronary syndrome [ACS]) and tests for interaction were further performed. Receiver operating characteristic (ROC) curve analysis was used to assess the discriminative ability of CTI for identifying vulnerable plaques. Results The study revealed that participants divided into CTI quartiles exhibited a steadily rising prevalence of macrophage accumulation and healed plaque. Compared with the low CTI groups (Q1 and Q2), the incidences of cholesterol crystals and multiple healed plaques (≥ 2) were significantly higher in the high CTI groups (Q3 and Q4) (cholesterol crystals: 35.1% and 24.3% vs. 18.9% and 13.5%; multiple healed plaques: 18.9% vs. 12.6%). After accounting for the effects of different covariates, analyzing CTI as a continuous variable revealed a significant link to healed plaque (OR = 1.62, 95%CI:1.21–2.16, P = 0.001), cholesterol crystals (OR = 1.64, 95%CI:1.17–2.30, P = 0.004), macrophage accumulation (OR = 1.49, 95%CI:1.13–1.98, P = 0.005), and plaque rupture (OR = 1.54, 95%CI:1.07–2.21, P = 0.019). The statistically significant association persisted when CTI was split into quartiles. Notably, stratified analyses revealed that these significant associations were only present in patients with ACS. The RCS analysis demonstrated a linear association between CTI and various lipid plaque-related parameters. The area under the ROC curve (AUC) demonstrated that CTI exhibited a stronger correlation with plaque vulnerability compared with other single factors. Conclusion In patients with ACS, elevated CTI is linked to an increased risk of healed plaque and vulnerable plaques. There is a linear relationship between CTI and various lipid plaque-related parameters. As a single factor, CTI provides a superior discriminative capacity for vulnerable plaque.