Abstract
BACKGROUND: Coronary microvascular dysfunction (CMD) after percutaneous coronary intervention (PCI) is a critical prognostic factor in acute coronary syndrome (ACS). This study aimed to evaluate the combined predictive value of the triglyceride-glucose index (TyG) and non-HDL-C/HDL-C ratio (NHHR) for CMD in ACS patients post-PCI. METHODS: A retrospective analysis of 542 ACS patients undergoing PCI (2021-2023) was conducted. Patients were classified into CMD (n=273) and non-CMD (n=269) groups based on CMD presence post-PCI. Baseline characteristics and biochemical markers were analyzed. TyG index and NHHR were calculated, and univariate and multivariate analyses were performed to identify predictors of CMD. ROC curves evaluated the predictive value of TyG combined with NHHR, while net reclassification index (NRI) and integrated discrimination improvement (IDI) assessed incremental predictive value. RESULTS: CMD patients exhibited significantly higher levels of TyG and NHHR compared to non-CMD patients. Multivariate logistic regression indicated that TyG (OR = 1.89, 95% CI: 1.24-2.88, P = 0.003) and NHHR (OR = 1.34, 95% CI: 1.11-1.62, P = 0.011) were independent predictors of CMD. The combined model showed significant improvement in discrimination (C-statistic increased from 0.750 to 0.782, P < 0.001) and reclassification (NRI = 0.458, IDI = 0.051, both P < 0.001). CONCLUSION: TyG and NHHR are novel predictors of CMD post-PCI, with combined use improving risk stratification. Given the retrospective nature of the study, further multicenter prospective research is required to validate these findings.