Triglyceride-glucose index predicts early, short-term, and long-term mortality after transcatheter aortic valve replacement.

Background: Despite transforming care for severe aortic stenosis, TAVR is still followed by early and late mortality. The triglyceride-glucose (TyG) index, an insulin-resistance marker from routine triglyceride and glucose levels, may flag high-risk patients in Ashkenazi-Jewish and Mediterranean individuals. We examined whether baseline TyG predicts all-cause mortality at 30 days, 1 year, and 3 years post-TAVR. Methods: We retrospectively studied patients with severe symptomatic aortic stenosis who underwent TAVR at a single tertiary center between 2010 and 2024. The TyG index was calculated from baseline triglyceride and glucose values. The primary endpoint was all-cause mortality at 1 year, with secondary endpoints of all-cause mortality at 30 days and 3 years. Cox proportional hazards models evaluated the association between TyG (per 1-unit increase) and mortality, adjusting for major clinical risk factors. Additionally, ROC curves were used to derive cohort-specific TyG thresholds for short-term and long-term mortality. Results: Results: A total of 821 TAVR patients were included. All-cause mortality was 3.4 % at 30 days, 10.9 % at 1 year, and 19.7 % at 3 years. Higher baseline TyG was associated with significantly increased mortality risk at all time points. After multivariable adjustment, each 1-unit increase in TyG index conferred a higher hazard of 1-year death (adjusted HR 1.62, 95 % CI 1.21-2.16) and remained predictive of mortality at 30 days (HR 1.92, 95 % CI 1.08-3.42) and 3 years (HR 1.42, 95 % CI 1.14-1.77). ROC analysis identified distinct TyG thresholds for short-term and long-term outcomes, with an optimal cut-point of 9.012 for 30-day mortality, 9.15 for 1-year mortality, and 8.700 for 3-year mortality. Conclusions: Baseline TyG index is an independent predictor of early, short-term, and long-term mortality after TAVR. The identification of cohort-specific TyG cut-points highlights population-specific metabolic risk calibration and supports the use of TyG as a simple and informative biomarker for refining risk stratification and follow-up intensity in TAVR recipients.