Objective  To evaluate the predictive abilities of the triglyceride and glucose (TyG) index, metabolic insulin resistance score (METSIR), and ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) for the risk of onset and severity of lesions in patients with acute coronary syndrome (ACS) complicated with multivessel coronary artery disease.

Methods  A retrospective analysis was conducted on the clinical data of 260 ACS patients admitted to Yunnan Provincial Third People's Hospital, and the patients were divided into multivessel disease group (n=160) and non-multivessel disease group (n=100); based on the SYNTAX score, the multivessel disease group was further divided into high-risk group with 71 cases (score>22.5) and low-risk group with 89 cases (score ≤22.5).

Results  The multivessel disease group had significantly higher proportions of males, history of diabetes, history of smoking, TyG index, METSIR, and TG/HDL-C compared to the non-multivessel disease group (P < 0.05). Correlation analysis showed that the TyG index and TG/HDL-C were significantly positively correlated with the SYNTAX score (P < 0.05), while METSIR had no correlation with the SYNTAX score (P>0.05). Logistic regression analysis indicated that METSIR was an independent risk factor for ACS complicated with multivessel coronary artery disease (P < 0.05), and TyG, METSIR and TG/HDL-C were all independent factors for predicting the severity of lesions (P < 0.05). Receiver operating characteristic (ROC) curve analysis showed that TyG had the highest predictive value for ACS complicated with multivessel coronary artery disease and its severity (area under the curve was 0.804).

Conclusion  The TyG index, METSIR, and TG/HDL-C are of great significance in the early identification and assessment of ACS complicated with multivessel coronary artery disease, with TyG having the highest predictive value.