{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T11:03:32Z","timestamp":1789556612201,"version":"build-2803163510"},"reference-count":37,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Evidence regarding the triglyceride\u2013glucose (TyG) index and premature myocardial infarction (MI) in non-diabetic adults remains limited. We evaluated whether pre-event TyG values were associated with premature MI in a propensity score-matched population. Methods: We retrospectively compared premature MI cases with non-diabetic controls undergoing coronary computed tomography angiography (CCTA) showing either no plaque or mild\/non-obstructive plaque. Propensity-based 1:1 matching on age, sex, body mass index (BMI), smoking, and hypertension resulted in 114 matched pairs. Conditional logistic regression, dose\u2013response analyses, restricted cubic spline (RCS) modeling, and incremental discrimination analyses were performed. Results: After propensity score matching, 228 patients (114 premature MI cases and 114 controls) were analyzed. The TyG index was independently associated with premature MI in conditional logistic regression (adjusted OR 2.704, 95% CI 1.408\u20135.192; p = 0.003). Compared with the lowest TyG tertile, the odds of premature MI increased progressively across higher tertiles (T2 vs. T1: adjusted OR 2.859, 95% CI 1.376\u20135.940; p = 0.005; T3 vs. T1: adjusted OR 4.424, 95% CI 1.859\u201310.531; p &lt; 0.001). Restricted cubic spline analysis demonstrated a significant overall association between the TyG index and premature MI (p = 0.003), with no evidence of nonlinearity (p = 0.286). Adding the TyG index to the clinical model increased the AUC from 0.647 to 0.696 (\u0394AUC = 0.050; DeLong p = 0.046). Matched-pair bootstrap analysis also supported an improvement in discrimination (95% CI for \u0394AUC 0.002\u20130.096; p = 0.034). Conclusions: Higher pre-event TyG values were independently associated with premature MI in non-diabetic adults, with a graded association across TyG levels and no significant evidence of nonlinearity. Incremental discrimination beyond the clinical model was modest but statistically supported by both DeLong and matched-pair bootstrap analyses. Prospective multicenter validation is warranted.<\/jats:p>","DOI":"10.3390\/diagnostics16182999","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T10:09:17Z","timestamp":1789553357000},"page":"2999","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of the Triglyceride\u2013Glucose Index with Premature Myocardial Infarction in a Propensity Score-Matched Non-Diabetic Population"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7055-8219","authenticated-orcid":false,"given":"Cagatay","family":"Onal","sequence":"first","affiliation":[{"name":"Department of Cardiology, Private Gazi Hospital, Nevzat Guzelirmak Street No. 29 Alsancak\/Kahramanlar, Izmir 35230, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Burak","family":"Ayca","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Buca Seyfi Demirsoy Training and Research Hospital, Izmir 35148, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e017712","DOI":"10.1161\/JAHA.120.017712","article-title":"Risk Factor Burden and Long-Term Prognosis of Patients With Premature Coronary Artery Disease","volume":"9","author":"Zeitouni","year":"2020","journal-title":"JAHA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2431","DOI":"10.1016\/j.jacc.2022.04.015","article-title":"Causes, Angiographic Characteristics, and Management of Premature Myocardial Infarction","volume":"79","author":"Rallidis","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1868","DOI":"10.1016\/j.jacc.2019.08.1002","article-title":"Long-Term Evolution of Premature Coronary Artery Disease","volume":"74","author":"Collet","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Liu, Q., Shi, R.-J., Zhang, Y.-M., Cheng, Y.-H., Yang, B.-S., Zhang, Y.-K., Huang, B.-T., and Chen, M. (2022). Risk Factors, Clinical Features, and Outcomes of Premature Acute Myocardial Infarction. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.1012095"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Gao, J., Wang, Y., Yang, Y.-N., Wu, X.-Y., Cui, Y., Zou, Z.-H., Cui, Z., and Liu, Y. (2022). Impact of Metabolic Syndrome and Its Components on Clinical Severity and Long-Term Prognosis in Patients With Premature Myocardial Infarction. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.920470"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"03000605231164548","DOI":"10.1177\/03000605231164548","article-title":"Insulin Resistance and Cardiovascular Disease","volume":"51","author":"Kosmas","year":"2023","journal-title":"J. Int. Med. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1186\/s12933-024-02276-1","article-title":"Insulin Resistance, Coronary Artery Lesion Complexity and Adverse Cardiovascular Outcomes in Patients with Acute Coronary Syndrome","volume":"23","author":"Chen","year":"2024","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1089\/met.2008.0034","article-title":"The Product of Fasting Glucose and Triglycerides As Surrogate for Identifying Insulin Resistance in Apparently Healthy Subjects","volume":"6","year":"2008","journal-title":"Metab. Syndr. Relat. Disord."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1186\/s12933-021-01268-9","article-title":"Triglyceride\u2013Glucose Index and the Incidence of Atherosclerotic Cardiovascular Diseases: A Meta-Analysis of Cohort Studies","volume":"20","author":"Ding","year":"2021","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s12933-023-01739-1","article-title":"Triglyceride Glucose Index Is Associated with Obstructive Coronary Artery Disease in Hypertensive Patients","volume":"22","author":"Pan","year":"2023","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Zhou, Y., Wang, Y., Chen, J., Jiang, L., Chu, R., Tian, W., Wang, J., Liu, Y., and Gao, J. (2026). The Association between Insulin Resistance Indices and the Occurrence of Major Adverse Cardiovascular Events in Patients with Premature Myocardial Infarction: A Prospective Cohort Study. Front. Nutr., 13.","DOI":"10.3389\/fnut.2026.1724362"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1186\/s12933-022-01576-8","article-title":"Triglyceride-Glucose Index in the Prediction of Adverse Cardiovascular Events in Patients with Premature Coronary Artery Disease: A Retrospective Cohort Study","volume":"21","author":"Wu","year":"2022","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1974","DOI":"10.1016\/j.jcmg.2022.07.002","article-title":"CAD-RADSTM 2.0\u20142022 Coronary Artery Disease-Reporting and Data System","volume":"15","author":"Cury","year":"2022","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e065780","DOI":"10.1136\/bmjopen-2022-065780","article-title":"Correlation of Triglyceride\u2013Glucose Index and Dyslipidaemia with Premature Coronary Heart Diseases and Multivessel Disease: A Cross-Sectional Study in Tianjin, China","volume":"12","author":"Wei","year":"2022","journal-title":"BMJ Open"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"83","DOI":"10.4274\/balkanmedj.galenos.2022-2-19","article-title":"Premature Myocardial Infarction: A Rising Threat","volume":"39","author":"Kayikcioglu","year":"2021","journal-title":"Balk. Med. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e618","DOI":"10.1161\/CIR.0000000000000617","article-title":"Fourth Universal Definition of Myocardial Infarction","volume":"138","author":"Thygesen","year":"2018","journal-title":"Circulation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the Management of Acute Coronary Syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e021682","DOI":"10.1161\/JAHA.121.021682","article-title":"Trends in Premature Mortality From Acute Myocardial Infarction in the United States, 1999 to 2019","volume":"11","author":"Dani","year":"2022","journal-title":"JAHA"},{"key":"ref_19","first-page":"10663","article-title":"Infarto agudo de miocardio prematuro con elevaci\u00f3n del segmento ST: An\u00e1lisis de una cohorte en la d\u00e9cada 2012\u20132022","volume":"93","author":"Elorriaga","year":"2024","journal-title":"ACM"},{"key":"ref_20","first-page":"2079","article-title":"Premature Acute Myocardial Infarction Treated With Invasive Revascularization: Comparing STEMI With NSTEMI in a Population-Based Study of Young Patients","volume":"40","author":"Roston","year":"2024","journal-title":"Can. J. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.mayocpiqo.2021.01.011","article-title":"Premature Myocardial Infarction: A Community Study","volume":"5","author":"Dugani","year":"2021","journal-title":"Mayo Clin. Proc. Innov. Qual. Outcomes"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1186\/s12944-017-0605-4","article-title":"Metabolic Syndrome, Diabetes and Inadequate Lifestyle in First-Degree Relatives of Acute Myocardial Infarction Survivors Younger than 45 Years Old","volume":"16","author":"Gurgel","year":"2017","journal-title":"Lipids Health Dis."},{"key":"ref_23","first-page":"6364","article-title":"Metabolic Score for Insulin Resistance Predicts Major Adverse Cardiovascular Event in Premature Coronary Artery Disease","volume":"16","author":"Guo","year":"2024","journal-title":"Aging"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1186\/s12933-023-02004-1","article-title":"Triglyceride-Glucose Index Is Associated with Severe Obstructive Coronary Artery Disease and Atherosclerotic Target Lesion Failure among Young Adults","volume":"22","author":"Shali","year":"2023","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e093092","DOI":"10.1136\/bmjopen-2024-093092","article-title":"Association between the Triglyceride-Glucose Index and Severe Left Main and\/or Three-Vessel Disease in Patients with Non-ST-Segment Elevation Myocardial Infarction: A Dual-Centre Retrospective Study","volume":"15","author":"Han","year":"2025","journal-title":"BMJ Open"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2351","DOI":"10.1016\/j.numecd.2020.07.041","article-title":"High Triglyceride-Glucose Index Is Associated with Adverse Cardiovascular Outcomes in Patients with Acute Myocardial Infarction","volume":"30","author":"Zhang","year":"2020","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Guo, Y., Cui, L., Guo, J., Jin, C., Xiu, L., Gao, Y., Zhao, C., Xu, X., Tan, J., and Han, J. (2025). The Triglyceride-Glucose Index Is Associated with Coronary Plaque Features and Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction. Front. Endocrinol., 16.","DOI":"10.3389\/fendo.2025.1665292"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1038\/s41598-023-51136-7","article-title":"Triglyceride-Glucose Body Mass Index Predicts Prognosis in Patients with ST-Elevation Myocardial Infarction","volume":"14","author":"Liu","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1186\/s12933-022-01694-3","article-title":"Association of Triglyceride\u2013Glucose Index and Traditional Risk Factors with Cardiovascular Disease among Non-Diabetic Population: A 10-Year Prospective Cohort Study","volume":"21","author":"Liu","year":"2022","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.5551\/jat.59840","article-title":"Triglyceride-Glucose Index as a Surrogate Marker of Insulin Resistance for Predicting Cardiovascular Outcomes in Nondiabetic Patients with Non-ST-Segment Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention","volume":"28","author":"Zhao","year":"2021","journal-title":"JAT"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1177\/10815589231182317","article-title":"Increased Triglyceride-Glucose Index Predicts Contrast-Induced Nephropathy in Non-Diabetic NSTEMI Patients: A Prospective Study","volume":"71","author":"Aktas","year":"2023","journal-title":"J. Investig. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1186\/s12933-024-02240-z","article-title":"The Prognostic Impact of Insulin Resistance Surrogates in Patients with Acute Myocardial Infarction with and without Type 2 Diabetes","volume":"23","author":"Rokicka","year":"2024","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"31490","DOI":"10.1038\/s41598-025-17315-4","article-title":"The Association between Triglyceride\u2013Glucose Index and the Recurrence of Myocardial Infarction in Young Patients with Previous Coronary Heart Disease","volume":"15","author":"Yang","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s12933-020-01210-5","article-title":"Triglyceride\u2013Glucose Index Is Associated with the Risk of Myocardial Infarction: An 11-Year Prospective Study in the Kailuan Cohort","volume":"20","author":"Tian","year":"2021","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/j.mayocpiqo.2021.03.009","article-title":"Risk Factors for Premature Myocardial Infarction: A Systematic Review and Meta-Analysis of 77 Studies","volume":"5","author":"Dugani","year":"2021","journal-title":"Mayo Clin. Proc. Innov. Qual. Outcomes"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2253","DOI":"10.24976\/Discov.Med.202436190.207","article-title":"Clinical Risk Factors and Characteristics of Coronary Artery Lesions in Premature Acute Myocardial Infarction Patients","volume":"36","author":"Wang","year":"2024","journal-title":"Discov. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"268","DOI":"10.5551\/jat.61119","article-title":"High Triglyceride-Glucose Index Is Associated with Poor Cardiovascular Outcomes in Nondiabetic Patients with ACS with LDL-C below 1.8 mmol\/l","volume":"29","author":"Zhang","year":"2022","journal-title":"JAT"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/18\/2999\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T10:18:35Z","timestamp":1789553915000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/18\/2999"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":37,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["diagnostics16182999"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16182999","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]}}}