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The Association of C-Reactive Protein-Triglyceride Glucose Index with Major Adverse Cardiovascular Events in Patients
Tao Wang1, Guoheng Zhang1, Qinxue Li1
1Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, People's Republic of China.
Insights
The C-reactive protein-triglyceride glucose index (CTI) shows greater promise in predicting major adverse cardiovascular events (MACEs) after acute myocardial infarction (AMI) than other markers. This integrated index offers improved risk stratification for AMI patients.
Area of Science:
- Cardiology
- Biomarkers
- Metabolic Syndrome
Background:
- The prognostic value of the C-reactive protein-triglyceride glucose index (CTI) for major adverse cardiovascular events (MACEs) following acute myocardial infarction (AMI) is not well-established.
- CTI integrates metabolic dysfunction and inflammation, key factors in cardiovascular disease.
Purpose of the Study:
- To evaluate the prognostic capability of CTI in predicting MACEs in patients with AMI.
- To compare the predictive performance of CTI against the triglyceride-glucose (TyG) index and high-sensitivity C-reactive protein (hs-CRP).
Main Methods:
- A retrospective study of 578 AMI patients from 2019-2022.
- Analysis included Receiver Operating Characteristic (ROC) curves, restricted cubic splines (RCS), Kaplan-Meier curves, and Cox regression models.
- Patients were stratified by CTI tertiles, and subgroup analyses were performed.
Main Results:
- Higher CTI tertiles correlated with increased MACEs risk (Log rank test, p = 0.003).
- CTI demonstrated superior predictive performance (AUC = 0.612) compared to TyG index (AUC = 0.562) and hs-CRP (AUC = 0.596).
- CTI significantly improved risk prediction (NRI and IDI) when added to baseline models, unlike TyG or hs-CRP.
Conclusions:
- CTI is a more effective predictor of MACEs in AMI patients than TyG index or hs-CRP alone.
- CTI's integration of inflammation and insulin resistance markers offers enhanced prognostic value for risk stratification.
- CTI may aid in identifying high-risk AMI patients for tailored management strategies.
Background:
The C-reactive protein-triglyceride glucose index (CTI), a novel marker that integrates metabolic dysfunction and inflammation, has an uncertain prognostic value for predicting major adverse cardiovascular events (MACEs) after acute myocardial infarction (AMI).
Methods:
This retrospective study enrolled 578 patients with AMI admitted to Xuanwu Hospital from 2019 to 2022. All patients were categorized according to tertiles of CTI values. Receiver operating characteristic (ROC) curves analysis and restricted cubic spline (RCS) were applied to explore the relationships of CTI, triglyceride-glucose (TyG) index, and high-sensitivity C-reactive protein (hs-CRP) with MACEs. Furthermore, the association between CTI and MACEs was evaluated using Kaplan-Meier curves and Cox proportional hazards regression models, with subgroup analyses assessing this relationship across various clinical conditions.
Results:
During a follow-up period with a median time of 34 months, 69 patients experienced MACEs, and higher CTI tertiles were associated with a greater cumulative risk of MACEs (Log rank test, p = 0.003). RCS analysis showed a positive linear association between CTI and MACEs risk (p-overall = 0.017). Compared with the TyG index (AUC = 0.562, 95% CI: 0.488-0.636) and hs-CRP (AUC = 0.596, 95% CI: 0.530-0.663), CTI demonstrated the highest AUC (0.612, 95% CI: 0.541-0.682). Importantly, the addition of CTI to the baseline model provided significant incremental prognostic value, with significant improvements in both net reclassification improvement (NRI) and integrated discrimination improvement (IDI), whereas neither the TyG index nor hs-CRP yielded significant improvements. Multivariate Cox regression analysis confirmed that the highest CTI tertile had a 3.09-fold increased risk of MACEs compared to the lowest tertile (p < 0.001) in the fully adjusted model, and the association remained stable across subgroups.
Conclusion:
The CTI is a more promising indicator for predicting MACEs in AMI patients than the TyG index or hs-CRP alone. By integrating the core risk factors of inflammation and insulin resistance, CTI may provide additional value for post-discharge risk stratification, helping to identify high-risk patients who may benefit from precise management.
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