Key result
Addition of the triglyceride-glucose index to a clinical model containing GRACE score, hemoglobin, and LVEF improved reclassification (IDI 0.038) for 6-month MACE in STEMI patients, but did not improve C-index discrimination.
Why the study?
Risk stratification after STEMI treated with PCI remains challenging, especially for identifying residual risk beyond established clinical scores, and the TyG index may provide additional prognostic information.
Does integrating the TyG index into a clinical model improve the prediction of 6-month MACE in STEMI patients undergoing primary PCI?
Cohort (n=169)
No
Does integrating the TyG index into a clinical model improve the prediction of 6-month MACE in STEMI patients undergoing primary PCI?
Effect estimate: IDI 0.038 (95% CI 0.007-0.086)
p-value: p=0.0038
Ambispective cohort study demonstrates improved risk reclassification using a triglyceride-glucose nomogram in myocardial infarction, suggesting enhanced residual risk tracking.
Risk stratification after ST‑elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) remains challenging, particularly for identifying residual risk beyond established clinical scores. The triglyceride–glucose (TyG) index, a surrogate marker of insulin resistance, may provide additional prognostic information. To develop and internally validate a TyG‑integrated nomogram for 6‑month major adverse cardiovascular events (MACE) after index hospital admission in STEMI patients undergoing PCI. In this single‑centre ambispective cohort, 169 consecutive STEMI patients treated with primary PCI were enrolled. The primary endpoint was time to first MACE within 6 months after index hospital admission, defined as all‑cause death, non‑fatal myocardial infarction, target‑vessel revascularisation, hospitalisation for unstable angina or heart failure, or stroke/transient ischaemic attack. Candidate predictors were analysed using Cox regression with elastic‑net penalisation. The final model included TyG index, GRACE score, hemoglobin, and left ventricular ejection fraction (LVEF). Apparent and bootstrap optimism-corrected model performance were assessed. Thirty-nine of 169 patients (23.1%) experienced a first MACE within 6 months after index hospital admission. Compared with the TyG-excluded clinical model containing GRACE score, hemoglobin, and LVEF, addition of TyG improved global model fit (likelihood-ratio χ2 = 8.36, df = 1, p = 0.0038; Akaike information criterion, 314.6 to 308.3) and reclassification (integrated discrimination improvement, 0.038; continuous net reclassification improvement, 0.574), but did not improve apparent or optimism-corrected C-index discrimination. The full model had an apparent C-index of 0.859 (95% confidence interval, 0.799–0.920), an optimism-corrected C-index of 0.848, and an optimism-corrected calibration slope of 0.923. A nomogram combining the TyG index with GRACE score, hemoglobin, and LVEF was associated with improved global model fit and reclassification relative to a TyG-excluded clinical model, but did not improve C-index discrimination. External validation in larger, contemporary cohorts is needed before clinical implementation.
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Hoang et al. (2026) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=169). Triglyceride-glucose (TyG) index vs. TyG-excluded clinical model (GRACE score, hemoglobin, LVEF) was evaluated on Time to first major adverse cardiovascular event (MACE) within 6 months (IDI 0.038, 95% CI 0.007-0.086, p=0.0038). Addition of the triglyceride-glucose index to a clinical model containing GRACE score, hemoglobin, and LVEF improved reclassification (IDI 0.038) for 6-month MACE in STEMI patients, but did not improve C-index discrimination.
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