Predictors of no-reflow phenomenon in patients with type 2 diabetes mellitus undergoing elective percutaneous coronary intervention: the emerging role of the triglyceride–glucose index

Abstract Objective To determine the prevalence and predictors of the no-reflow phenomenon in patients with type 2 diabetes mellitus (T2DM) undergoing elective percutaneous coronary intervention and to evaluate the predictive value of the triglyceride–glucose (TyG) index. Methods This prospective observational cohort study included 137 patients with T2DM scheduled for elective percutaneous coronary intervention at two tertiary centres. Patients were classified according to postprocedural Thrombolysis in Myocardial Infarction flow grade into normal reflow and no-reflow groups. Clinical, laboratory, echocardiographic, angiographic and procedural variables were compared. Receiver operating characteristic curve analysis and multivariable logistic regression were performed to assess predictive performance and independent predictors. Results The no-reflow phenomenon occurred in 13 patients (9.5%). Patients with no-reflow had a significantly longer diabetes duration, higher fasting blood glucose, random blood glucose, glycated haemoglobin, low-density lipoprotein cholesterol, triglyceride and TyG index values, and lower left ventricular ejection fraction compared with patients with normal reflow. Severe coronary stenosis and pre-dilatation were significantly more frequent in the no-reflow group. The TyG index demonstrated the highest predictive performance for no-reflow (area under the curve [AUC] = 0.870, 95% confidence interval [CI]: 0.753–0.987, p < 0.001). A TyG cutoff value of approximately 9.01 yielded 76.9% sensitivity and 89.5% specificity. Multivariable logistic regression identified the TyG index as an independent predictor of no-reflow (odds ratio [OR] = 2.05 per 0.1-unit increase, 95% CI 1.26–3.32, p = 0.004), together with duration of diabetes and reduced ejection fraction. Conclusions No-reflow occurred in approximately 1 in 10 diabetic patients undergoing elective percutaneous coronary intervention. The TyG index is a simple, inexpensive and effective marker for preprocedural risk stratification.