The Prognostic Value of the Triglyceride-Glucose and Fibrosis-4 Indices in Patients Undergoing Coronary Angiography: A Retrospective Cohort Analysis

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-04-01 DOI:10.1016/j.cjco.2025.01.005

Amir Aker MD , Tom Tarchitzky BsC , Yuval Avidan MD , Barak Zafrir MD

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Abstract

Background

The triglyceride-glucose (TYG) index, which reflects insulin resistance, and the fibrosis-4 (FIB-4) index, a measure of liver fibrosis, are noninvasive laboratory-based indicators associated with cardiometabolic risk.

Methods

We performed a retrospective analysis of 12,165 patients who underwent coronary angiography, to investigate the association of the TYG and FIB-4 indices with the occurrence of myocardial infarction, stroke, or all-cause death (major cardiovascular events [MACE]), using multivariate Cox proportional hazards models.

Results

The mean age of the study population was 65 ± 10 years; 63% presented with acute coronary syndrome. During a median follow-up period of 6.1 years, the first MACE occurred in 4174 patients. Compared to the TYG index ≤ 50th percentile (≤ 8.81), the multivariable adjusted hazard ratio (95% confidence interval) for MACE was 1.17 (1.10-1.45), 1.32 (1.23-1.43), and 1.72 (1.55-1.99) for TYG index levels ≥ 50th (> 8.81), ≥ 75th (> 9.23), and ≥ 90th (9.66) percentiles, respectively. FIB-4 index levels of 1.3-2.67 and > 2.67 were associated with an adjusted hazard ratio of 1.19 (1.11-1.27) and 1.67 (1.51-1.87), respectively, compared to FIB-4 index levels of < 1.3. Regarding the risk of developing MACE, no significant interaction was detected between TYG or FIB-4 index levels and the presence of diabetes or obesity. In a combined model of both predictive measures, a gradual increase in the incidence rate of MACE was observed, ranging from 3.93 (TYG index ≤ 8.81; FIB-4 index < 1.3) to 8.56 (TYG index > 9.23; FIB-4 index > 2.67) events per 100 patient-years.

Conclusions

The TYG and FIB-4 indices, both individually and when concomitantly elevated, were independently associated with an increased risk of developing MACE in patients undergoing coronary angiography. ,. These simple-to-calculate, noninvasive metabolic biomarkers may aid in the prediction of cardiovascular diseases.

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