Association between Triglyceride-Glucose Index and Prognosis in Critically Ill Patients with Acute Coronary Syndrome: Evidence from the MIMIC Database

Background: This study aimed to investigate the association between triglyceride-glucose (TyG) index and prognosis in critically ill patients with acute coronary syndrome (ACS), exploring potential heterogeneity of the association among patient subgroups with different characteristics. Methods: Records of patients with ACS were extracted from the MIMIC-IV database. The association between TyG index and mortality was analyzed using Cox proportional-hazard regression model, while potential non-linear associations were assessed using restricted cubic spline (RCS) regression. Meanwhile, linear regression model was used to explore the association between TyG index and length of stay in hospital or ICU. Subpopulation Treatment Effect Pattern Plot (STEPP) was utilized to explore the potential heterogeneous subgroups. Time-dependent Receiver Operating Characteristic (ROC) curve analyses were performed to compare the predictive ability of different Cox proportional-hazard regression models (with or without TyG index). Results: A total of 849 patients were enrolled. Multivariate Cox regression analyses demonstrated that TyG index was significantly associated with 28-day mortality (HR:2.13 [95%CI: 1.23-3.68], P<0.01) and 365-day mortality (HR:1.65 [95%CI: 1.11-2.47], P<0.01). RCS regression analyses revealed an inverted U-shaped association between TyG index and 28-day mortality (P for non-linearity=0.027) and a linear association between TyG index and 365-day mortality (P for non-linearity =0.086). There were subgroups specified by age for 28-day mortality (P for interaction=0.04) and 365-day mortality (P for interaction<0.01), with a cut-off point of 70 years old obtained by STEPP. TyG index was associated with a higher risk of mortality in subgroups aged ≤ 70 years old. Time-dependent ROC curve suggested that TyG index could slightly improve the prediction of mortality. A higher TyG index was associated with longer time of stay in hospital (β: 1.79 [95%CI: 0.06-3.52], P=0.04). Conclusions: A higher TyG index is associated with both short-term and long-term all-cause mortality in critically ill patients with ACS, especially in short-term all-cause mortality. TyG index is associated with higher mortality risk in patient subgroups aged ≤ 70 years old. A higher TyG index is associated with longer time of stay in hospital. TyG index may serve as a useful prognostic marker for patient management and strategic decision-making in clinical settings.