Predictors of no-reflow phenomenon in patients with type 2 diabetes mellitus undergoing elective percutaneous coronary intervention: the emerging role of the triglyceride–glucose index

Hala Mahfouz Badran; Mohamed Kadry Ghazy Mohamed; Ghada Mahmoud Soltan; Awny Gamal Shalaby

doi:10.2478/rjc-2026-0024

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Predictors of no-reflow phenomenon in patients with type 2 diabetes mellitus undergoing elective percutaneous coronary intervention: the emerging role of the triglyceride–glucose index

Romanian Journal of Cardiology

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By: Hala Mahfouz Badran, Mohamed Kadry Ghazy Mohamed, Ghada Mahmoud Soltan and Awny Gamal Shalaby

Open Access

|Sep 2026

Abstract

Objective

To determine the prevalence and predictors of the no-reflow phenomenon in patients with type 2 diabetes mellitus (T2DM) undergoing elective percutaneous coronary intervention and to evaluate the predictive value of the triglyceride–glucose (TyG) index.

Methods

This prospective observational cohort study included 137 patients with T2DM scheduled for elective percutaneous coronary intervention at two tertiary centres. Patients were classified according to postprocedural Thrombolysis in Myocardial Infarction flow grade into normal reflow and no-reflow groups. Clinical, laboratory, echocardiographic, angiographic and procedural variables were compared. Receiver operating characteristic curve analysis and multivariable logistic regression were performed to assess predictive performance and independent predictors.

Results

The no-reflow phenomenon occurred in 13 patients (9.5%). Patients with no-reflow had a significantly longer diabetes duration, higher fasting blood glucose, random blood glucose, glycated haemoglobin, low-density lipoprotein cholesterol, triglyceride and TyG index values, and lower left ventricular ejection fraction compared with patients with normal reflow. Severe coronary stenosis and pre-dilatation were significantly more frequent in the no-reflow group. The TyG index demonstrated the highest predictive performance for no-reflow (area under the curve [AUC] = 0.870, 95% confidence interval [CI]: 0.753–0.987, p < 0.001). A TyG cutoff value of approximately 9.01 yielded 76.9% sensitivity and 89.5% specificity. Multivariable logistic regression identified the TyG index as an independent predictor of no-reflow (odds ratio [OR] = 2.05 per 0.1-unit increase, 95% CI 1.26–3.32, p = 0.004), together with duration of diabetes and reduced ejection fraction.

Conclusions

No-reflow occurred in approximately 1 in 10 diabetic patients undergoing elective percutaneous coronary intervention. The TyG index is a simple, inexpensive and effective marker for preprocedural risk stratification.

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Articles in this issue

DOI: https://doi.org/10.2478/rjc-2026-0024 | Journal eISSN: 2734-6382 | Journal ISSN: 1220-658X

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Language: English

Published on: Sep 19, 2026

Published by: Romanian Society of Cardiology

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

no-reflow phenomenon,

percutaneous coronary intervention,

type 2 diabetes mellitus,

triglyceride-glucose index,

Related subjects:

Pediatrics and juvenile medicine,

Paediatric cardiology,

Surgery,

Cardiac surgery

© 2026 Hala Mahfouz Badran, Mohamed Kadry Ghazy Mohamed, Ghada Mahmoud Soltan, Awny Gamal Shalaby, published by Romanian Society of Cardiology
This work is licensed under the Creative Commons Attribution 4.0 License.

AHEAD OF PRINT