The C-reactive protein-triglyceride-glucose index and incident heart failure subtypes in stable coronary artery disease and type 2 diabetes after PCI: A prospective cohort study

Background : The C-reactive protein–triglyceride–glucose index (CTI) is a composite marker of systemic inflammation and insulin resistance. Its association with heart failure (HF) subtypes in patients with stable coronary artery disease and type 2 diabetes mellitus after percutaneous coronary intervention remains unclear. Aims : Our aim was to examine the association of baseline CTI with incident HF with preserved ejection fraction (HFpEF), HF with left ventricular ejection fraction (LVEF) <50%, and major adverse cardiovascular events (MACEs). Methods : We prospectively enrolled patients with stable coronary artery disease and type 2 diabetes mellitus undergoing percutaneous coronary intervention during 2016–2022. Patients were stratified into CTI tertiles and followed through 2025. Associations were assessed using Cox models, Kaplan–Meier analysis, and competing-risk models. Results : Among 2524 patients (median age 70 years, 67.5% male), 321 HF events (183 HFpEF and 138 with LVEF <50%) and 653 MACEs occurred over 57 months. Higher CTI was independently associated with HFpEF (adjusted hazard ratio [HR], 1.228; 95% confidence interval [CI], 1.006–1.500; P = 0.04), whereas the association with LVEF <50% showed a trend (HR, 1.199; CI, 0.990–1.452; P = 0.06) but emerged in the highest vs. lowest tertile (subdistribution HR, 1.86; CI, 1.22–2.83; P = 0.004). CTI was also associated with MACEs (HR, 1.215; CI, 1.074–1.374; P = 0.002). Conclusions : Elevated CTI was independently associated with increased risk of incident HF and MACEs. The association appeared more pronounced for HFpEF than for HF with LVEF <50%, though formal statistical comparison between subtypes was not performed.