TyG-BMI and TyG/BMI %: valuable evaluation tools for predicting unfavorable prognosis in ischemic stroke patients with large vessel occlusion after endovascular therapy

Abstract

Background: Insulin resistance (IR) indices, such as triglyceride-glucose (TyG) and TyG with body mass index (TyG-BMI), are strongly associated with all-cause mortality (ACM) from ischemic or hemorrhagic stroke. However, the relationship between IR indices and adverse outcomes of ischemic stroke patients remains unclear, and no studies have explored whether the TyG/BMI ratio is more predictive than TyG-BMI.

Methods: In this study, we calculated four IR-related indicators and followed up regularly to assess modified Rankin Scale (mRS) scores. Multivariate logistic regression analyses were used to explore the associations of these indicators with adverse outcomes at 3 and 12 months. Restrictive cubic splines (RCS) evaluated the dose-effect relationships. Subgroup analyses assessed the prognostic efficacy of TyG-BMI and TyG/BMI %, with favorable outcomes defined as mRS scores of 0-2.

Results: Of the 823 patients, 603 were included in the study cohort, with 331 (54.89 %) unable to live independently at 3 months (mRS>2). Among the four IR indexes, lower TyG-BMI and higher TyG/BMI % were significantly associated with poor prognosis after EVT, particularly at 12 months, showing linear or S-shaped dose-response relationships. TyG-BMI and TyG/BMI % improved the accuracy and efficiency of predicting prognosis at 3 and 12 months by enhancing IDI and NRI. In subgroup analyses, TyG/BMI % was effective across most subgroups, except for sex, indicating broad applicability in managing stroke outcomes.

Conclusion: Both TyG-BMI and TyG/BMI % were significantly associated with prognosis of patients with AIS-LVO after EVT, particularly at the 12-month follow-up. Notebly, TyG/BMI % exhibited a more favorable trend in predictive performance and risk stratification capability.

Keywords: Acute ischemic stroke with large vessels occlusion; EVT; Insulin resistance; Stroke prognosis; TyG/BMI %.