No-reflow phenomenon and triglyceride-glucose index in acute myocardial infarction

Murat Kerkutluoglu 1 * , Enes Celik 2, Musa Dagli 1, Hakan Gunes 1
More Detail
1 Department of Cardiology, Sutcu Imam University, Faculty of Medicine, Kahramanmaras, Turkey
2 Department of Cardiology, Idil State Hospital, Sirnak, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 20, Issue 4, pp. 27-32.
OPEN ACCESS 705 Views 440 Downloads
Download Full Text (PDF)


Objective: The objective of this research was to evaluate the association between the measured triglyceride/glucose index (TyG) and the occurrence of no-reflow phenomena in patients with acute ST-elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (PCI).
Material and methods: This study comprised 242 patients who were treated with primary PCI for acute STEMI. The values of triglycerides and glucose at the time of admission were derived from the patient's file. Using coronary angiography records, the grade of post-procedural thrombolysis in myocardial infarction (TIMI) flow was determined.
Results: After PCI, patients were divided into two groups based on their TIMI flow grade: the normal coronary flow group (n=202) and the reduced coronary flow (no-reflow) group (n=40). The group with no-reflow had a poorer left ventricular ejection fraction and a higher prevalence of diabetes compared to the group with normal coronary flow. Individuals with a lower grade of TIMI flow had a substantially higher TyG index (9.7±0.25 vs. 8.8±0.5, p=0.001). The receiver operating characteristic (ROC) curve revealed that the optimal cut-off point of the TyG index for predicting no-reflow was >9.2 with specificity of 72.8% and sensitivity of 97.5% (area under the curve = 0.884; 95% confidence interval, 0.837-0.921; p=0.001).
Conclusion: At admission, patients with STEMI who experienced no reflow after primary PCI had a higher TyG index. In such cases, the TyG index can be utilized as a predictor of no-reflow.


Kerkutluoglu M, Celik E, Dagli M, Gunes H. No-reflow phenomenon and triglyceride-glucose index in acute myocardial infarction. J CLIN MED KAZ. 2023;20(4):27-32.


  • Dauerman HL, Ibanez B. The Edge of Time in Acute Myocardial Infarction. J Am Coll Cardiol. 2021;77(15):1871-1874.
  • Chan W, Stub D, Clark DJ, Ajani AE, Andrianopoulos N, Brennan AL, et al. Usefulness of transient and persistent no reflow to predict adverse clinical outcomes following percutaneous coronary intervention. Am J Cardiol. 2012;109(4):478-85.
  • Valero SJ, Moreno R, Reyes RM, Recalde AS, Galeote G, Calvo L, et al. Pharmacological approach of no-reflow phenomenon related with percutaneous coronary interventions. Cardiovasc Hematol Agents Med Chem. 2008;6(2):125-9.
  • Nishio M, Ueda Y, Matsuo K, Tsujimoto M, Hao H, Asai M, et al. Association of target lesion characteristics evaluated by coronary computed tomography angiography and plaque debris distal embolization during percutaneous coronary intervention. Circ J. 2014;78(9):2203-8.
  • Tartan Z, Ozer N, Uyarel H, Akgul O, Gul M, Cetin M, et al. Metabolic syndrome is a predictor for an ECG sign of no-reflow after primary PCI in patients with acute ST-elevation myocardial infarction. Nutr Metab Cardiovasc Dis. 2008;18(6):441-7.
  • Gesteiro E, Bastida S, Barrios L, Sánchez-Muniz FJ. The triglyceride-glucose index, an insulin resistance marker in newborns? Eur J Pediatr. 2018;177(4):513-520.
  • Won KB, Park EJ, Han D, Lee JH, Choi SY, Chun EJ, et al. Triglyceride glucose index is an independent predictor for the progression of coronary artery calcification in the absence of heavy coronary artery calcification at baseline. Cardiovasc Diabetol. 2020;19(1):34.
  • Zhang S, Du T, Zhang J, Lu H, Lin X, Xie J, et al. The triglyceride and glucose index (TyG) is an effective biomarker to identify nonalcoholic fatty liver disease. Lipids Health Dis. 2017;16(1):15.
  • Li X, Li G, Cheng T, Liu J, Song G, Ma H. Association between triglyceride-glucose index and risk of incident diabetes: a secondary analysis based on a Chinese cohort study: TyG index and incident diabetes. Lipids Health Dis. 2020;19(1):236.
  • Zhao S, Yu S, Chi C, Fan X, Tang J, Ji H, et al. Association between macro- and microvascular damage and the triglyceride glucose index in community-dwelling elderly individuals: the Northern Shanghai Study. Cardiovasc Diabetol. 2019;18(1):95.
  • Vafaie M. State-of-the-art diagnosis of myocardial infarction. Diagnosis (Berl). 2016;3(4):137-142.
  • Rezkalla SH, Kloner RA. Coronary no-reflow phenomenon: From the experimental laboratory to the cardiac catheterization laboratory. 2008;72 (7): 950-7.
  • Simental-Mendía LE, Rodríguez-Morán M, GuerreroRomero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord. 2008;6(4):299- 304.
  • Delibegovic M, Zimmer D, Kauffman C, Rak K, Hong EG, Cho YR, et al. Liver-specific deletion of protein-tyrosine phosphatase 1B (PTP1B) improves metabolic syndrome and attenuates diet-induced endoplasmic reticulum stress. Diabetes. 2009;58(3):590-9.
  • Du T, Yuan G, Zhang M, Zhou X, Sun X, Yu X. Clinical usefulness of lipid ratios, visceral adiposity indicators, and the triglycerides and glucose index as risk markers of insulin resistance. Cardiovasc Diabetol. 2014;13:146.
  • Ormazabal V, Nair S, Elfeky O, Aguayo C, Salomon C, Zuñiga FA. Association between insulin resistance and the development of cardiovascular disease. Cardiovasc Diabetol. 2018;17(1):122.
  • Bierman EL. Atherogenesis in diabetes. Arterioscler Thromb. 1992;12:647- 656.
  • Hermanides J, Cohn DM, Devries JH, Kamphuisen PW, Huijgen R, Meijers JC, et al. Venous thrombosis is associated with hyperglycemia at diagnosis: a case-control study. J Thromb Haemost. 2009;7(6):945-9.
  • Hunt KJ, Baker N, Cleary P, Backlund JY, Lyons T, Jenkins A, et al. Oxidized LDL and AGE-LDL in circulating immune complexes strongly predict progression of carotid artery IMT in type 1 diabetes. Atherosclerosis. 2013;231(2):315-22.
  • Zhu L, He Z, Wu F, Ding R, Jiang Q, Zhang J, et al. Immunization with advanced glycation end products modified low density lipoprotein inhibits atherosclerosis progression in diabetic apoE and LDLR null mice. Cardiovasc Diabetol. 2014;13:151.
  • Habets KL, van Puijvelde GH, van Duivenvoorde LM, van Wanrooij EJ, de Vos P, Tervaert JW, et al. Vaccination using oxidized low-density lipoprotein-pulsed dendritic cells reduces atherosclerosis in LDL receptor-deficient mice. Cardiovasc Res. 2010;85(3):622-30.
  • Simental-Mendía LE, Hernández-Ronquillo G, Gómez-Díaz R, Rodríguez-Morán M, Guerrero-Romero F. The triglycerides and glucose index is associated with cardiovascular risk factors in normal-weight children and adolescents. Pediatr Res. 2017;82(6):920-925.
  • Hong S, Han K, Park CY. The triglyceride glucose index is a simple and low-cost marker associated with atherosclerotic cardiovascular disease: a population-based study. BMC Med. 2020; 18: 361.
  • Luo E, Wang D, Yan G, Qiao Y, Liu B, Hou J,et al. High triglyceride-glucose index is associated with poor prognosis in patients with acute ST-elevation myocardial infarction after percutaneous coronary intervention. Cardiovasc Diabetol. 2019;18(1):150.
  • Menees DS, Peterson ED, Wang Y, Curtis JP, Messenger JC, Rumsfeld JS, et al. Door-to-balloon time and mortality among patients undergoing primary PCI. N Engl J Med. 2013;369(10):901-9.
  • Choo EH, Kim PJ, Chang K, Ahn Y, Jeon DS, Lee JM, et al. The impact of no-reflow phenomena after primary percutaneous coronary intervention: a time-dependent analysis of mortality. Coron Artery Dis. 2014;25(5):392-8.
  • Engstrøm T, Kelbæk H, Helqvist S, Høfsten DE, Kløvgaard L, Clemmensen P, et al. Effect of Ischemic Postconditioning During Primary Percutaneous Coronary Intervention for Patients With ST-Segment Elevation Myocardial Infarction: A Randomized Clinical Trial. JAMA Cardiol. 2017;2(5):490-497.
  • Fischesser DM, Bo B, Benton RP, Su H, Jahanpanah N, Haworth KJ. Controlling Reperfusion Injury With Controlled Reperfusion: Historical Perspectives and New Paradigms. J Cardiovasc Pharmacol Ther. 2021;26(6):504-523.
  • Tsalamandris S, Antonopoulos AS, Oikonomou E, Papamikroulis GA, Vogiatzi G, Papaioannou S, et al. The Role of Inflammation in Diabetes: Current Concepts and Future Perspectives. Eur Cardiol. 2019;14(1):50-59.
  • Iwakura K, Ito H, Ikushima M, Kawano S, Okamura A, Asano K, et al. Association between hyperglycemia and the no-reflow phenomenon in patients with acute myocardial infarction. J Am Coll Cardiol. 2003;41(1):1-7.
  • Yip HK, Chen MC, Chang HW, Hang CL, Hsieh YK, Fang CY, et al. Angiographic morphologic features of infarct-related arteries and timely reperfusion in acute myocardial infarction: predictors of slow-flow and no-reflow phenomenon. Chest. 2002;122(4):1322-32.
  • Li S, Guo B, Chen H, Shi Z, Li Y, Tian Q, et al. The role of the triglyceride (triacylglycerol) glucose index in the development of cardiovascular events: a retrospective cohort analysis. Sci Rep. 2019;9(1):7320.