Association between TyG-related indices and in-hospital acute heart failure in patients with acute myocardial infarction after emergency percutaneous coronary intervention

Abstract

Aim: Acute heart failure (AHF) may still occur during hospitalization in some patients with acute myocardial infarction (AMI) after emergency percutaneous coronary intervention (PCI). Triglyceride-glucose (TyG)-related indices are useful markers for evaluating insulin resistance. However, the association between TyG-related indices and in-hospital AHF in AMI patients following emergency PCI remains incompletely understood. The present study aimed to investigate the relationship between TyG-related indices and in-hospital AHF in these patients, with the goal of providing potential clinical evidence for the early identification and management of high-risk individuals. Methods: This retrospective study enrolled patients with AMI who underwent emergency PCI at our hospital from January 2023 to December 2025. LASSO regression analysis was applied to screen relevant variables. Logistic regression, restricted cubic spline curves and subgroup analysis were performed to evaluate the effects of key variables. Results: A total of 885 patients were enrolled. Levels of the TyG index, TyG‑body mass index (TyG‑BMI), TyG‑waist‑to‑height ratio (TyG‑WHtR), and TyG‑waist circumference (TyG‑WC) were significantly higher in patients with AHF. LASSO regression identified 12 risk variables, which were further analyzed using logistic regression and subgroup analyses. Logistic regression demonstrated that the TyG‑WHtR was associated with a significantly elevated risk of AHF (OR: 2.29, 95% CI: 1.35–3.91, P<0.01). Receiver operating characteristic (ROC) curve analysis indicated that the TyG‑WHtR exhibited a relatively high discriminative performance for AHF, with an area under the curve (AUC) of 0.759 (95% CI: 0.721–0.797). TyG‑related indices were stratified and analyzed by quartiles. Results showed that higher quartiles were significantly associated with an increased risk of AHF across all models. Restricted cubic spline (RCS) models revealed linear relationships between TyG, TyG‑BMI, TyG‑WHtR, TyG‑WC and AHF following adjustment for covariates (P‑overall < 0.05, P‑nonlinear > 0.05). Subgroup analysis indicated that the TyG‑BMI was more strongly associated with incident AHF among patients with the left anterior descending artery (LAD) as the culprit vessel (P for interaction < 0.05). Conclusions: Poor control of TyG-related indices is associated with an increased in-hospital risk of AHF in AMI patients after emergency PCI. Among these indices, the TyG-WHtR may serve as a relatively important and independent predictor.