Triglyceride–Glucose Index as a Surrogate Marker of Insulin Resistance and Its Association with Angiographic Severity of Coronary Artery Disease in Acute Coronary Syndrome

Abstract

Objectives: To evaluate the association between the triglyceride–glucose (TyG) index, a surrogate marker of insulin resistance, and angiographic severity of coronary artery disease (CAD) in patients presenting with acute coronary syndrome (ACS). Methodology: This analytical cross-sectional study was conducted at the Choudhary Pervaiz Elahi Institute of Cardiology (CPEIC), Multan. A total of 196 patients aged 18–65 years presenting with ACS were enrolled. All participants underwent coronary angiography during index hospitalization to determine CAD severity. The TyG index was calculated using fasting triglyceride and glucose levels obtained after supervised overnight fasting, using the formula ln [triglycerides (mg/dL) × glucose (mg/dL) / 2]. Patients were categorized into TyG <8.88 and ≥8.88 groups based on established literature thresholds. The association between TyG index and CAD severity was analyzed using Chi-square testing and multinomial logistic regression. Results: The mean age of the study population was 46.72 ± 13.34 years, and 81.6% were male. The mean TyG index was 8.69 ± 0.91, with 59.7% of patients categorized as having TyG ≥8.88. Triple-vessel disease was present in 75.5% of participants. A significant association was observed between higher TyG index and greater CAD severity (p <0.001). Multinomial logistic regression demonstrated that both TyG index (B=1.43, p <0.001) and BMI (B=0.70, p <0.001) were independently associated with severe CAD after adjustment for traditional cardiovascular risk factors. Conclusion: The TyG index is significantly associated with angiographic severity of coronary artery disease in patients with acute coronary syndrome. As a simple, low-cost, and readily available marker of insulin resistance, the TyG index may provide additional value in identifying patients at risk of extensive multi-vessel coronary disease. Prospective studies are warranted to further validate its role in clinical risk stratification.