Work

Prognostic value of the C-reactive protein-triglyceride-glucose index (CTI) for major adverse cardiovascular events in patients with coronary artery disease: a retrospective cohort study

Year: 2026

Type: article

Abstract: Background and aims Coronary artery disease (CAD) is a leading cause of cardiovascular death, highlighting the need for improved risk stratification. The C-reactive protein-triglyceride-glucose index (CTI) is a novel integrated biomarker that captures the synergistic effects of metabolic and inflammatory pathways by combining C-reactive protein (CRP), triglycerides (TG) and glucose. However, its prognostic value for long-term major adverse cardiovascular events (MACE) in patients with CAD remains unclear. Method This single-centre retrospective cohort study included 1533 newly diagnosed CAD patients stratified by admission CTI tertiles (T1: <8.744, n=511; T2: 8.744–9.367, n=512; T3: ≥9.367, n=510). The primary endpoint, MACE (397 events), was confirmed via medical records and follow-up. Group comparisons were performed using ANOVA/Kruskal-Wallis or χ2 tests, as appropriate. Multivariable Cox proportional hazards regression was used to assess the independent association between CTI and MACE, with sequential adjustment for confounders. Kaplan-Meier curves and receiver operating characteristic (ROC) curves were applied. Analyses were conducted using SPSS 26.0, with a two-sided p<0.05 considered significant. Results In the fully adjusted Cox model, elevated CTI remained significantly associated with an increased risk of MACE (per 1-unit increase: HR 1.851, 95% CI 1.632 to 2.098; p<0.001). Compared with the lowest tertile (T1), the highest CTI tertile (T3, ≥9.367) was associated with a significantly higher MACE risk (HR 1.936, 95% CI 1.538 to 2.437; p<0.001). Kaplan-Meier analysis revealed a dose-dependent relationship (log-rank p=0.001). ROC curve analysis yielded an area under the curve of 0.698 (95% CI 0.666 to 0.769), with an optimal CTI cut-off of ≥9.49 (sensitivity 53.9%, specificity 79.8%). Sensitivity analyses adjusting for potential mediators confirmed the robustness of these findings. Conclusions Based on Cox proportional hazards regression analysis, CTI is an independent predictor of MACE risk in patients with CAD. CTI offers superior prognostic value over its individual components and may assist in risk assessment. However, larger prospective studies are needed to validate its clinical utility before routine application.

Source: BMJ Open

DOI: 10.1136/bmjopen-2026-119720