The Triglyceride‐Glucose Index Stratifies Cardiovascular Risk After PCI: A Cohort Study Identifying the Highest‐Risk Patients

Background The triglyceride‐glucose (TyG) index is a surrogate marker of insulin resistance, but its prognostic value across guideline‐defined cardiovascular risk strata remains unclear. Methods In this retrospective cohort study, 23,592 patients undergoing percutaneous coronary intervention (PCI) were stratified into non‐high‐risk (VHR0), high‐risk (VHR1), and very‐high‐risk (VHR2) groups based on contemporary atherosclerotic cardiovascular disease criteria. The TyG index was evaluated as continuous and categorical (tertiles) variables. Primary endpoint was a 3‐year composite of cardiovascular death, non‐fatal myocardial infarction, or stroke (CV events). Results During a median follow‐up of 3.1 years, elevated TyG was independently associated with increased risks of CV events only in the VHR2 group (adjusted HR 1.51 for T3 vs. T1, 95% CI 1.10–2.08, p = 0.011). In VHR2 patients, adding TyG to a baseline risk model significantly improved reclassification (NRI 0.1251, p = 0.035) and discrimination (IDI 0.0028, p = 0.002). No significant associations were found in VHR0 or VHR1 groups. Conclusion The TyG index independently predicts 3‐year cardiovascular events specifically in very‐high‐risk patients after PCI and provides incremental prognostic utility, supporting its use for refined risk stratification and personalized secondary prevention in this high‐risk population.