Background: Insulin resistance (IR) is a major contributor to the development, progression, and poor outcomes of coronary artery disease (CAD). The triglyceride–glucose (TyG) index, calculated from fasting triglyceride and glucose titres, is proposed as a simple, reliable and cost-effective surrogate marker for IR. Multiple studies have linked higher TyG index values with cardiovascular disease (CVD) progression, mortality, and major adverse cardiovascular events (MACE). Nevertheless, its routine clinical application remains limited, and the biological mechanisms connecting the TyG index to cardiovascular pathology are not yet fully understood.
Methods: A systematic literature review was performed using the electronic databases PubMed, Scopus, and Web of Science, that evaluated the prognostic and diagnostic significance of the TyG index in acute coronary syndrome (ACS). The review included investigations analyzing associations between TyG values and outcomes like mortality, MACE in ACS.
Conclusion: The TyG index offers prognostic insights that extend beyond conventional cardiovascular risk factors and demonstrates superior predictive ability compared with fasting glucose or triglycerides alone. In ACS, elevated TyGi are associated with greater cardiovascular risk, emphasizing its usefulness as a practical biomarker for early risk stratification. The index reflects insulin resistance in hepatic and adipose tissues which enhance inflammatory burden that promotes atherosclerosis, endothelial dysfunction, platelet activation, and diminished cardiac reserve. However, its clinical implementation is hindered by variability across populations and gaps in mechanistic understanding. Further longitudinal studies are warranted to validate its predictive role in CAD