The prognostic value of triglyceride glucose–waist height ratio index in patients with heart failure after acute myocardial infarction: a retrospective study

Background Heart failure (HF) after acute myocardial infarction (AMI) remains a major clinical challenge. The triglyceride glucose-waist-to-height ratio (TyG-WHtR) integrates metabolic and obesity indices, yet its prognostic value for AMI-HF is unclear. Methods This retrospective study enrolled 738 AMI patients undergoing PCI from January 2019 to June 2024. Baseline TyG-WHtR was calculated pre-discharge. The primary outcome was HF occurrence within 1-year follow-up. Multivariate logistic regression and restricted cubic splines (RCS) assessed associations. Receiver operating characteristic (ROC) curves and DeLong tests compared TyG-WHtR against the GRACE score and other metabolic indices. Subgroup analyses were performed based on AMI-to-PCI time and ESC-defined HF classifications. Results A total of 136 patients (18.4%) developed HF. TyG-WHtR was an independent predictor of AMI-HF (adjusted OR = 1.192, 95% CI: 1.021∼1.392, p = 0.026), persisting after adjusting for the post-PCI GRACE score. RCS revealed a positive nonlinear dose-response relationship (p-nonlinear=0.034). TyG-WHtR demonstrated good discrimination (AUC=0.769, 95% CI: 0.726∼0.811), outperforming TyG-WC and TyG-BMI (both p < 0.05). Notably, TyG-WHtR showed superior predictive value in HFpEF (AUC=0.815) compared to GRACE (AUC=0.761, p = 0.012), whereas GRACE performed better in HFrEF. The predictive value was consistent across AMI-to-PCI time strata (p-interaction=0.584). Baseline TyG-WHtR correlated inversely with 1-year LVEF (r = −0.327, p < 0.001) in HF patients. Conclusion TyG-WHtR is an independent risk factor for 1-year AMI-HF, particularly in HFpEF phenotypes. It provides incremental prognostic value beyond the GRACE score and may guide early risk stratification in post-PCI AMI patients.