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Background <p>The C-reactive protein–triglyceride–glucose index (CTI), which integrates inflammation, lipid metabolism, and glucose metabolism, has emerged as a composite biomarker for metabolic and cardiovascular disease. This study aimed to evaluate the association between CTI and major adverse cardiovascular and cerebral events (MACCEs) in patients with acute coronary syndrome (ACS) and type 2 diabetes mellitus (T2DM), and to determine whether CTI adds prognostic information beyond conventional clinical variables and its individual components.</p> Methods <p>This single-center observational cohort study included 5,472 patients with ACS and T2DM treated at the Cardiovascular Centre of Beijing Friendship Hospital from January 2013 to January 2021. CTI was calculated as 0.412 × ln(C-reactive protein [mg/L]) + ln(triglyceride [mg/dL] × fasting plasma glucose [mg/dL]/2). The primary endpoint was MACCEs, defined as a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, and ischemia-driven revascularization. Kaplan–Meier curves and multivariable Cox regression were supplemented by comparisons of CTI, the triglyceride-glucose (TyG) index, and ln(CRP), Harrell C-index, time-dependent area under the curve (AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), calibration, decision curve analysis, ACS-subtype analyses, multiple imputation, proportional-hazards diagnostics, landmark analyses, and competing-risk analyses.</p> Results <p>During a median follow-up of 3.04 (IQR: 1.07–5.02) years, 1,075 MACCEs occurred. In univariable Cox analysis, each 1-unit increase in CTI was associated with a higher risk of MACCEs (HR 1.24, 95% CI 1.17–1.32; <i>P</i> &lt; 0.001). After multivariable adjustment, CTI remained independently associated with MACCEs (HR 1.26, 95% CI 1.17–1.36; <i>P</i> &lt; 0.001). When analyzed by quartiles, compared with Q1, the multivariable-adjusted HRs (95% CIs) were 1.09 (0.90–1.33) for Q2, 1.44 (1.19–1.74) for Q3, and 1.75 (1.43–2.14) for Q4. Per 1-SD increase, the adjusted HRs were 1.27 (1.18–1.36) for CTI, 1.10 (1.02–1.17) for TyG, and 1.29 (1.20–1.39) for ln(CRP). Adding CTI to the clinical model increased the C-index from 0.688 to 0.694 and the 3-year AUC from 0.727 to 0.737, with an NRI of 0.293 and an IDI of 0.009. The corresponding ln(CRP) model achieved a C-index of 0.698 and a 3-year AUC of 0.744. Associations were consistent across UAP, NSTEMI, and STEMI (P for interaction = 0.59).</p> Conclusion <p>CTI was independently associated with an increased risk of MACCEs in patients with ACS and T2DM and provided modest incremental prognostic information beyond conventional clinical variables. However, its discriminatory performance was not clearly superior to ln(CRP) alone or to jointly modeled ln(CRP) and TyG. CTI should therefore be considered an adjunctive admission biomarker rather than a replacement for established clinical assessment.</p>

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Association of the C-reactive protein–triglyceride–glucose index with adverse cardiovascular outcomes in patients with acute coronary syndrome and type 2 diabetes: findings from an observational cohort study in China

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  • 发表日期：

    2026年7月30日

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  • Xiaoquan He,
  • Man Wang,
  • Ping Wang,
  • Daokuo Yao,
  • Rongchong Huang,
  • Huiqiang Zhao,
  • Xiantao Song

摘要

Background

The C-reactive protein–triglyceride–glucose index (CTI), which integrates inflammation, lipid metabolism, and glucose metabolism, has emerged as a composite biomarker for metabolic and cardiovascular disease. This study aimed to evaluate the association between CTI and major adverse cardiovascular and cerebral events (MACCEs) in patients with acute coronary syndrome (ACS) and type 2 diabetes mellitus (T2DM), and to determine whether CTI adds prognostic information beyond conventional clinical variables and its individual components.

Methods

This single-center observational cohort study included 5,472 patients with ACS and T2DM treated at the Cardiovascular Centre of Beijing Friendship Hospital from January 2013 to January 2021. CTI was calculated as 0.412 × ln(C-reactive protein [mg/L]) + ln(triglyceride [mg/dL] × fasting plasma glucose [mg/dL]/2). The primary endpoint was MACCEs, defined as a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, and ischemia-driven revascularization. Kaplan–Meier curves and multivariable Cox regression were supplemented by comparisons of CTI, the triglyceride-glucose (TyG) index, and ln(CRP), Harrell C-index, time-dependent area under the curve (AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), calibration, decision curve analysis, ACS-subtype analyses, multiple imputation, proportional-hazards diagnostics, landmark analyses, and competing-risk analyses.

Results

During a median follow-up of 3.04 (IQR: 1.07–5.02) years, 1,075 MACCEs occurred. In univariable Cox analysis, each 1-unit increase in CTI was associated with a higher risk of MACCEs (HR 1.24, 95% CI 1.17–1.32; P < 0.001). After multivariable adjustment, CTI remained independently associated with MACCEs (HR 1.26, 95% CI 1.17–1.36; P < 0.001). When analyzed by quartiles, compared with Q1, the multivariable-adjusted HRs (95% CIs) were 1.09 (0.90–1.33) for Q2, 1.44 (1.19–1.74) for Q3, and 1.75 (1.43–2.14) for Q4. Per 1-SD increase, the adjusted HRs were 1.27 (1.18–1.36) for CTI, 1.10 (1.02–1.17) for TyG, and 1.29 (1.20–1.39) for ln(CRP). Adding CTI to the clinical model increased the C-index from 0.688 to 0.694 and the 3-year AUC from 0.727 to 0.737, with an NRI of 0.293 and an IDI of 0.009. The corresponding ln(CRP) model achieved a C-index of 0.698 and a 3-year AUC of 0.744. Associations were consistent across UAP, NSTEMI, and STEMI (P for interaction = 0.59).

Conclusion

CTI was independently associated with an increased risk of MACCEs in patients with ACS and T2DM and provided modest incremental prognostic information beyond conventional clinical variables. However, its discriminatory performance was not clearly superior to ln(CRP) alone or to jointly modeled ln(CRP) and TyG. CTI should therefore be considered an adjunctive admission biomarker rather than a replacement for established clinical assessment.