Association Between the Triglyceride-glucose index and Cardiovascular Risk in ACS Patients with Impaired Renal Function

Background The prognostic value of the triglyceride-glucose (TyG) index across different renal function strata remains unclear. The study explores the association between the TyG index and major adverse cardiovascular events (MACE) in acute coronary syndrome (ACS) patients at different eGFR levels. Methods A total of 1038 patients with ACS were analyzed, and 241 composite events were recorded during the follow-up. Kaplan-Meier survival analysis and the Cox proportional hazard model were used to determine the relationship between TyG index and the incidence of MACE. Results Patients in the highest TyG index tertile (TyG ≥ 9.25) presented a higher median age, male predominance, and greater prevalence of STEMI and UA. The TyG index was an independent predictor of MACE, with a progressively higher MACE incidence observed across ascending TyG tertiles. The restricted cubic spline analysis showed a linear association between the TyG index and MACE risk in the unadjusted model and a J-shaped association after multivariate adjustment. Notably, this association was present in patients with impaired renal function (eGFR < 60 mL/min/1.73m ² ), where the risk of MACE increased by 43% for every one standard deviation increase in TyG index (HR 1.43, 95% CI: 1.05–1.95, P  = 0.025). However, this relationship was not observed in patients with preserved renal function. Conclusion Elevated TyG index is an independent risk factor for MACE, particularly in patients with renal impairment. These findings suggests that the TyG index is a valuable clinical marker for cardiovascular risk stratification, especially in patients with renal insufficiency.