Association of triglyceride-glucose index with major adverse cardiovascular events after coronary artery bypass grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Ziran , WANG Sujuan , GUO Yajun ,  JIANG Yanyan

Department of Cardiac Surgery Ward 1, The 7th People’s Hospital of Zhengzhou, Zhengzhou, 450016, P. R. China;

Corresponding author：

JIANG Yanyan, Email: 13526551155@163.com

Keywords：

Triglyceride-glucose index; coronary artery bypass grafting; adverse cardiovascular events

DOI：

10.7507/1007-4848.202505066

Video：

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Objective To investigate the predictive value of the triglyceride glucose (TyG) index in major adverse cardiovascular events (MACE) in patients after coronary artery bypass graft (CABG) surgery. Methods A retrospective collection of patients with coronary atherosclerotic heart disease who underwent CABG treatment in the Department of Cardiac Surgery Ward 1, the 7th People’s Hospital of Zhengzhou, from 2015 to 2024 was conducted. The X-tile software was used to calculate the nearest cutoff value of the TyG index, and patients were divided into groups based on this optimal cutoff value. The association between the TyG index and MACE was explored through univariate analysis, Kaplan-Meier survival curve analysis, and Cox regression analysis. The predictive ability of the TyG index was evaluated by important factor ranking and the area under the receiver operating characteristic curve (AUC). Results A total of 998 patients were included, with 630 patients having a TyG index ≤8.80, including 438 males and 192 females, with a median age of 55 (60, 65) years; and 368 patients with a TyG index >8.80, including 236 males and 132 females, with a median age of 57 (63, 69) years. Cumulative survival curves showed that the incidence of MACE in the TyG≤8.80 group was significantly lower than in the TyG>8.80 group (log-rank test, P<0.001). Cox regression analysis indicated that TyG>8.80 was an independent risk factor for MACE [HR=2.581, 95%CI (1.201, 5.549), P<0.001]. In the important factor ranking, the TyG index had the greatest impact on MACE. The TyG index could enhance the predictive ability of the MACE prediction model, with the AUC increasing from 0.712 to 0.872. Conclusion The TyG index can serve as an effective predictive indicator for MACE after CABG surgery.

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2.	Martin SS, Aday AW, Allen NB, et al. 2025 heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation, 2025, 151(8): e41-e660.
3.	Besola L, Colli A, De Caterina R. Coronary bypass surgery for multivessel disease after percutaneous coronary intervention in acute coronary syndromes: why, for whom, how early? Eur Heart J, 2024, 45(34): 3124-3131.
4.	Liga R, Colli A, Taggart DP, et al. Myocardial revascularization in patients with ischemic cardiomyopathy: for whom and how. J Am Heart Assoc, 2023, 12(6): e026943.
5.	Kim JH, Lee PH, Kim HJ, et al. Incidence and predictors of intracranial bleeding after coronary artery bypass graft surgery. Front Cardiovasc Med, 2022, 9: 863590.
6.	Jafarkhani A, Imani B, Saeedi S, et al. Predicting factors affecting survival rate in patients undergoing on-pump coronary artery bypass graft surgery using machine learning methods: a systematic review. Health Sci Rep, 2025, 8(1): e70336.
7.	Ren Q, Li G, Chu T, et al. Off-pump versus on-pump coronary artery bypass grafting in diabetic patients: a meta-analysis of observational studies with a propensity-score analysis. Cardiovasc Drugs Ther, 2024.
8.	Kogan A, Ram E, Levin S, et al. Impact of type 2 diabetes mellitus on short- and long-term mortality after coronary artery bypass surgery. Cardiovasc Diabetol, 2018, 17(1): 151.
9.	Li X, Sun M, Yang Y, et al. Predictive effect of triglyceride glucose-related parameters, obesity indices, and lipid ratios for diabetes in a chinese population: a prospective cohort study. Front Endocrinol (Lausanne), 2022, 13: 862919.
10.	Son DH, Lee HS, Lee YJ, et al. Comparison of triglyceride-glucose index and HOMA-IR for predicting prevalence and incidence of metabolic syndrome. Nutr Metab Cardiovasc Dis, 2022, 32(3): 596-604.
11.	Sun X, Wu Z, Guo D, et al. Triglyceride-glucose index as a superior marker of insulin resistance for predicting long-term major adverse cardiovascular events following coronary artery bypass grafting in china. Sci Rep, 2025, 15(1): 6450.
12.	Wu Z, Guo D, Chen S, et al. Combination of the triglyceride-glucose index and EuroSCOREⅡ improves the prediction of long-term adverse outcomes in patients undergoing coronary artery bypass grafting. Diabetes Metab Res Rev, 2023, 39(8): e3710.
13.	Wu Z, Xie L, Guo D, et al. Triglyceride-glucose index in the prediction of adverse cardiovascular events in patients without diabetes mellitus after coronary artery bypass grafting: a multicenter retrospective cohort study. Cardiovasc Diabetol, 2023, 22(1): 230.
14.	He J, Song C, Yuan S, et al. Triglyceride-glucose index as a suitable non-insulin-based insulin resistance marker to predict cardiovascular events in patients undergoing complex coronary artery intervention: a large-scale cohort study. Cardiovasc Diabetol, 2024, 23(1): 15.
15.	Pacini G, Mari A. Methods for clinical assessment of insulin sensitivity and beta-cell function. Best Pract Res Clin Endocrinol Metab, 2003, 17(3): 305-322.
16.	Rudvik A, Mansson M. Evaluation of surrogate measures of insulin sensitivity-correlation with gold standard is not enough. BMC Med Res Methodol, 2018, 18(1): 64.
17.	Huang R, Lin Y, Ye X, et al. Triglyceride-glucose index in the development of heart failure and left ventricular dysfunction: analysis of the ARIC study. Eur J Prev Cardiol, 2022, 29(11): 1531-1541.
18.	Huang R, Xu X, Xu C, et al. Association between the insulin resistance and all-cause mortality in patients with moderate and severe aortic stenosis: a retrospective cohort study. Cardiovasc Diabetol, 2023, 22(1): 238.
19.	Yang Y, Huang X, Wang Y, et al. The impact of triglyceride-glucose index on ischemic stroke: a systematic review and meta-analysis. Cardiovasc Diabetol, 2023, 22(1): 2.
20.	Ormazabal V, Nair S, Elfeky O, et al. Association between insulin resistance and the development of cardiovascular disease. Cardiovasc Diabetol, 2018, 17(1): 122.
21.	Tao LC, Xu JN, Wang TT, et al. Triglyceride-glucose index as a marker in cardiovascular diseases: landscape and limitations. Cardiovasc Diabetol, 2022, 21(1): 68.
22.	Di Angelantonio E, Kaptoge S, Wormser D, et al. Association of cardiometabolic multimorbidity with mortality. JAMA, 2015, 314(1): 52-60.
23.	Alizargar J, Bai CH, Hsieh NC, et al. Use of the triglyceride-glucose index (TyG) in cardiovascular disease patients. Cardiovasc Diabetol, 2020, 19(1): 8.
24.	Ke Z, Huang R, Xu X, et al. Long-term high level of insulin resistance is associated with an increased prevalence of coronary artery calcification: the CARDIA study. J Am Heart Assoc, 2023, 12(11): e028985.
25.	Holman RR, Paul SK, Bethel MA, et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med, 2008, 359(15): 1577-1589.
26.	Nissen SE, Nicholls SJ, Wolski K, et al. Comparison of pioglitazone vs glimepiride on progression of coronary atherosclerosis in patients with type 2 diabetes: the PERISCOPE randomized controlled trial. JAMA, 2008, 299(13): 1561-1573.
27.	Andrikou E, Tsioufis C, Andrikou I, et al. GLP-1 receptor agonists and cardiovascular outcome trials: an update. Hellenic J Cardiol, 2019, 60(6): 347-351.

1. Wu L, Shi Y, Kong C, et al. Dietary inflammatory index and its association with the prevalence of coronary heart disease among 45, 306 US adults. Nutrients, 2022, 14(21): 4553.
2. Martin SS, Aday AW, Allen NB, et al. 2025 heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation, 2025, 151(8): e41-e660.
3. Besola L, Colli A, De Caterina R. Coronary bypass surgery for multivessel disease after percutaneous coronary intervention in acute coronary syndromes: why, for whom, how early? Eur Heart J, 2024, 45(34): 3124-3131.
4. Liga R, Colli A, Taggart DP, et al. Myocardial revascularization in patients with ischemic cardiomyopathy: for whom and how. J Am Heart Assoc, 2023, 12(6): e026943.
5. Kim JH, Lee PH, Kim HJ, et al. Incidence and predictors of intracranial bleeding after coronary artery bypass graft surgery. Front Cardiovasc Med, 2022, 9: 863590.
6. Jafarkhani A, Imani B, Saeedi S, et al. Predicting factors affecting survival rate in patients undergoing on-pump coronary artery bypass graft surgery using machine learning methods: a systematic review. Health Sci Rep, 2025, 8(1): e70336.
7. Ren Q, Li G, Chu T, et al. Off-pump versus on-pump coronary artery bypass grafting in diabetic patients: a meta-analysis of observational studies with a propensity-score analysis. Cardiovasc Drugs Ther, 2024.
8. Kogan A, Ram E, Levin S, et al. Impact of type 2 diabetes mellitus on short- and long-term mortality after coronary artery bypass surgery. Cardiovasc Diabetol, 2018, 17(1): 151.
9. Li X, Sun M, Yang Y, et al. Predictive effect of triglyceride glucose-related parameters, obesity indices, and lipid ratios for diabetes in a chinese population: a prospective cohort study. Front Endocrinol (Lausanne), 2022, 13: 862919.
10. Son DH, Lee HS, Lee YJ, et al. Comparison of triglyceride-glucose index and HOMA-IR for predicting prevalence and incidence of metabolic syndrome. Nutr Metab Cardiovasc Dis, 2022, 32(3): 596-604.
11. Sun X, Wu Z, Guo D, et al. Triglyceride-glucose index as a superior marker of insulin resistance for predicting long-term major adverse cardiovascular events following coronary artery bypass grafting in china. Sci Rep, 2025, 15(1): 6450.
12. Wu Z, Guo D, Chen S, et al. Combination of the triglyceride-glucose index and EuroSCOREⅡ improves the prediction of long-term adverse outcomes in patients undergoing coronary artery bypass grafting. Diabetes Metab Res Rev, 2023, 39(8): e3710.
13. Wu Z, Xie L, Guo D, et al. Triglyceride-glucose index in the prediction of adverse cardiovascular events in patients without diabetes mellitus after coronary artery bypass grafting: a multicenter retrospective cohort study. Cardiovasc Diabetol, 2023, 22(1): 230.
14. He J, Song C, Yuan S, et al. Triglyceride-glucose index as a suitable non-insulin-based insulin resistance marker to predict cardiovascular events in patients undergoing complex coronary artery intervention: a large-scale cohort study. Cardiovasc Diabetol, 2024, 23(1): 15.
15. Pacini G, Mari A. Methods for clinical assessment of insulin sensitivity and beta-cell function. Best Pract Res Clin Endocrinol Metab, 2003, 17(3): 305-322.
16. Rudvik A, Mansson M. Evaluation of surrogate measures of insulin sensitivity-correlation with gold standard is not enough. BMC Med Res Methodol, 2018, 18(1): 64.
17. Huang R, Lin Y, Ye X, et al. Triglyceride-glucose index in the development of heart failure and left ventricular dysfunction: analysis of the ARIC study. Eur J Prev Cardiol, 2022, 29(11): 1531-1541.
18. Huang R, Xu X, Xu C, et al. Association between the insulin resistance and all-cause mortality in patients with moderate and severe aortic stenosis: a retrospective cohort study. Cardiovasc Diabetol, 2023, 22(1): 238.
19. Yang Y, Huang X, Wang Y, et al. The impact of triglyceride-glucose index on ischemic stroke: a systematic review and meta-analysis. Cardiovasc Diabetol, 2023, 22(1): 2.
20. Ormazabal V, Nair S, Elfeky O, et al. Association between insulin resistance and the development of cardiovascular disease. Cardiovasc Diabetol, 2018, 17(1): 122.
21. Tao LC, Xu JN, Wang TT, et al. Triglyceride-glucose index as a marker in cardiovascular diseases: landscape and limitations. Cardiovasc Diabetol, 2022, 21(1): 68.
22. Di Angelantonio E, Kaptoge S, Wormser D, et al. Association of cardiometabolic multimorbidity with mortality. JAMA, 2015, 314(1): 52-60.
23. Alizargar J, Bai CH, Hsieh NC, et al. Use of the triglyceride-glucose index (TyG) in cardiovascular disease patients. Cardiovasc Diabetol, 2020, 19(1): 8.
24. Ke Z, Huang R, Xu X, et al. Long-term high level of insulin resistance is associated with an increased prevalence of coronary artery calcification: the CARDIA study. J Am Heart Assoc, 2023, 12(11): e028985.
25. Holman RR, Paul SK, Bethel MA, et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med, 2008, 359(15): 1577-1589.
26. Nissen SE, Nicholls SJ, Wolski K, et al. Comparison of pioglitazone vs glimepiride on progression of coronary atherosclerosis in patients with type 2 diabetes: the PERISCOPE randomized controlled trial. JAMA, 2008, 299(13): 1561-1573.
27. Andrikou E, Tsioufis C, Andrikou I, et al. GLP-1 receptor agonists and cardiovascular outcome trials: an update. Hellenic J Cardiol, 2019, 60(6): 347-351.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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