Predictive Value of Triglyceride/HDL-C Ratio for Unplanned Coronary Revascularization in Elderly Patients With Type 2 Diabetes and Coronary Artery Disease: A Retrospective Cohort Study.

Objectives: The triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio reflects atherogenic dyslipidemia and insulin resistance. Its predictive value for unplanned coronary revascularization in elderly patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) is unclear. Methods: We retrospectively analyzed 1796 patients aged ≥ 60 years with T2DM and angiographically confirmed CAD from January 2008 to November 2021. The primary endpoint was unplanned coronary revascularization, defined as revascularization performed because of angina symptoms, new ischemic changes on ECG, or signs of reversible myocardial ischemia on noninvasive imaging. TG/HDL-C ratio was evaluated by tertiles in Kaplan-Meier analysis and as a continuous variable in Cox models: Model 1 (unadjusted), Model 2 (age, gender, smoking), and Model 3 (further adjusted for lipid, metabolic, renal, and angiographic covariates). Restricted cubic spline (RCS) analysis and prespecified subgroup analyses were performed. Results: During a median follow-up of 1175 days (interquartile range, 597-1986), unplanned revascularization occurred in 309 patients (17.2%). In the fully adjusted model, TG/HDL-C ratio remained independently associated with increased risk (per 1-unit increase: hazard ratio [HR] 1.029, 95% confidence interval [CI] 1.007-1.051, p = 0.011; per standard deviation increase: HR 1.158, 95% CI 1.039-1.290, p = 0.008). Compared with the lowest tertile, the highest tertile showed a significantly higher risk of unplanned revascularization (HR = 1.646, 95% CI = 1.133-2.393, p < 0.010). The RCS analysis demonstrated a relatively flat risk below approximately 3.427, with a progressive increase thereafter (p for overall association = 0.006; p for nonlinearity = 0.045). Subgroup analyses showed no statistically significant interactions (all p for interaction > 0.05), and the direction of association was consistent across predefined clinical strata. Conclusion: Higher TG/HDL-C ratio independently predicted unplanned revascularization in elderly patients with T2DM and CAD. This simple, widely available lipid parameter may aid long-term risk stratification, but prospective multicenter studies are needed for validation.