Predictive value of combined triglyceride-glucose index and glycated hemoglobin for long-term cardiovascular outcomes in stable coronary artery disease

Abstract

Abstract Background: Insulin resistance (IR) affects prognosis in stable coronary artery disease (SCAD). While triglyceride-glucose (TyG) index assesses IR, glycated hemoglobin (HbA1c) provides long-term glycemic level information. However, the combined predictive value of TyG index and HbA1c is unclear. Methods: This retrospective cohort study included 944 SCAD patients who underwent percutaneous coronary intervention (PCI). Major adverse cardiovascular events (MACE) were followed up for 31 months. Receiver operating characteristic (ROC) curves assessed the predictive ability of TyG index, HbA1c and their combination. Patients were further grouped based on the optimal cutoff value of the TyG index and clinical abnormal ranges of HbA1c to analyze the impact of different groups. Results: The TyG index was independently predictive of MACE and repeat revascularization (HR: 1.574, P = 0.021; and HR: 1.379, P = 0.027). Combining TyG index with HbA1c significantly enhanced overall MACE prediction, with the AUC for cardiac death increasing to 0.901 (P = 0.016). The high TyG-low HbA1c group had more than double the cumulative incidence of MACE compared to the low TyG-low HbA1c group (HR: 2.069, P < 0.001), with the high TyG-high HbA1c group showing an even greater risk (HR: 2.463, P < 0.001). Diabetic patients in the high TyG-low HbA1c category had the highest risk increase (HR: 3.375, P = 0.038). Conclusions: The combined use of TyG and HbA1c improves the predictive ability for MACE in all SCAD patients, with predictive value for chronic outcomes, but not for acute events.