Percutaneous coronary intervention (PCI) is the preferred reperfusion therapy for acute myocardial infarction (AMI). However, the slow flow/no-reflow phenomenon is a significant predictor of poor prognosis after PCI.

To evaluate the predictive value of the triglyceride-glucose body mass index (TyG-BMI) for slow flow/no-reflow events in patients with type 2 diabetes mellitus (T2DM) and AMI undergoing emergency PCI.

This retrospective study included 368 patients with T2DM and AMI admitted to Department of Cardiology and Macrovascular Diseases, Beijing Tiantan Hospital, Capital Medical University, from July 2020 to December 2023. Patients were divided into normal flow group (TIMI 3, n=292) and slow flow/no-reflow group (TIMI 0-2, n=76) based on TIMI scores. Univariate and multivariate Logistic regression analyses were used to identify influencing factors for slow flow/no-reflow in patients with T2DM and AMI. The receiver operating characteristic (ROC) curve was plotted to assess the predictive value of TyG-BMI for slow flow/no-reflow. The incremental effect of TyG-BMI on the baseline risk model was evaluated using the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) indices.

The slow flow/no-reflow group had higher age, female proportion, smoking rate, history of coronary artery disease, TyG-BMI, right coronary artery (RCA) infarction rate, white blood cell count, C-reactive protein, serum creatinine, triglycerides (TG), fasting plasma glucose (FPG), and TyG-BMI than the normal flow group (P<0.05). Hemoglobin, estimated glomerular filtration rate (eGFR), left ventricular ejection fraction (LVEF), thrombus aspiration rate, left anterior descending artery (LAD) infarction rate, and statin use rate were lower in the slow flow/no-reflow group than in the normal flow group (P<0.05). Multivariate Logistic regression analysis showed that TyG-BMI (OR=4.25, 95%CI=2.92-6.18), age (OR=1.05, 95%CI=1.02-1.08), C-reactive protein (OR=1.12, 95%CI=1.09-1.15), LVEF (OR=0.96, 95%CI=0.96-0.99), statin use (OR=0.72, 95%CI=0.61-0.85), LAD (OR=0.29, 95%CI=0.15-0.56), and RCA lesion (OR=2.68, 95%CI=1.96-3.66) were influencing factors for slow flow/no-reflow in AMI patients (P<0.05). Incremental effect analysis showed that adding TyG-BMI significantly improved the reclassification and discrimination of the baseline risk model, with NRI=0.075 and IDI=0.068 (P<0.05) .

Elevated TyG-BMI is associated with an increased risk of slow flow/no reflow in patients with diabetes mellitus and AMI following PCI. TyG-BMI is an effective predictor of the slow flow/no reflow phenomenon. Compared with FPG and TG, the addition of TyG-BMI can significantly improve the reclassification and discrimination ability of the baseline risk model.