The Role of Triglyceride/HDL Ratio, Triglyceride–Glucose Index, and Pan-Immune-Inflammation Value in the Differential Diagnosis of Acute Coronary Syndrome and Predicting Mortality

Objectives: We aimed to evaluate the predictive importance of various clinical and laboratory parameters in the differential diagnosis of Acute Coronary Syndrome (ACS). Understanding these predictors is critical for improving diagnostic accuracy, guiding therapeutic decisions, and ultimately enhancing patient outcomes. Methods: The study included a total of 427 patients diagnosed with ACS, comprising 142 with unstable angina, 142 with non-ST elevation myocardial infarction (NSTEMI), and 143 with ST elevation myocardial infarction (STEMI). The data were collected from medical records of patients treated at a tertiary care hospital between January 2020 and December 2024. In addition to other biochemical parameters, triglyceride/HDL ratio (THR), triglyceride–glucose index (TGI), and Pan-Immune-Inflammation Value (PIV) were calculated and compared. Results: THR, TGI, PIV, and mortality rate were statistically higher in the STEMI group (p = 0.034, p = 0.031, p = 0.022, p = 0.045, respectively). The risk factors were found to be significantly associated with STEMI in the multiple logistic regression analysis and included age, total cholesterol, triglycerides, diabetes mellitus, smoking, cTnI, LVEF, THR, TGI, and PIV. High THR increases the risk of STEMI (AUC = 0.67, 95% CI: 0.62–0.72, p = 0.020). High THR increases the risk of mortality in ACS patients (AUC = 0.70, 95% CI: 0.65–0.75, p = 0.004). THRs above 3.5 are associated with higher risk. Sensitivity is 75% and specificity is 60%. High TGI increases the risk of mortality in ACS patients (AUC = 0.73, 95% CI: 0.68–0.78, p = 0.007). TGIs above 8.5 are associated with higher risk. Sensitivity is 78% and specificity is 63%. High PIVs increase the risk of mortality in ACS patients (AUC = 0.75, 95% CI: 0.70–0.80, p = 0.009). PIVs above 370 are associated with higher risk. Sensitivity is 80% and specificity is 65%. The combination of TGI, THR, PIV, and cTnI has the highest predictive capability over individual parameters for STEMI and mortality. Conclusions: We found that age, total cholesterol, triglycerides, cTnI, THR, TGI, and PIV increase, low LVEF, presence of diabetes mellitus, and smoking have predictive values for STEMI and mortality in patients with ACS. Unlike the studies in the literature, this is the first study in which cTnI, THR, TGI, and PIV values were evaluated together in ACS and mortality prediction.