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

		Reflow (n = 124)	No-reflow (n = 13)	p-value
Age (years)	Mean ± SD	65.31 ± 5.83	66.69 ± 6.47	0.471
BMI (kg/m²)	Mean ± SD	28.31 ± 1.70	29.89 ± 2.93	0.078
Duration of diabetes	Mean ± SD	8.08 ± 3.98	13.77 ± 4.83	0.001*
Sex—male	n (%)	93 (75.00)	10 (76.92)	1.000
Sex—female	n (%)	31 (25.00)	3 (23.08)
Smoking	n (%)	65 (52.42)	7 (53.85)	0.922
HTN	n (%)	93 (75.00)	10 (76.92)	1.000
Dyslipidaemia	n (%)	83 (66.94)	9 (69.23)	1.000
Known IHD	n (%)	17 (13.71)	2 (15.38)	1.000
Aspirin	n (%)	105 (84.68)	11 (84.62)	1.000
Clopidogrel	n (%)	97 (78.23)	10 (76.92)	1.000
Beta-blocker	n (%)	86 (69.35)	10 (76.92)	0.754
Statin	n (%)	79 (63.71)	8 (61.54)	1.000
ACEi/ARBs	n (%)	57 (45.97)	6 (46.15)	1.000

ACEi, angiotensin-converting enzyme inhibitor; ARBs, angiotensin receptor blockers; BMI, body mass index; HTN, hypertension; IHD, ischaemic heart disease; SD, standard deviation

* Significant

Table 2

Haemodynamic parameters, laboratory findings and cardiac function according to reflow status

		Reflow (n = 124)	No-reflow (n = 13)	p-value
HR	Mean ± SD	87.40 ± 11.55	88.38 ± 12.36	0.788
Systolic BP	Mean ± SD	132.83 ± 12.15	134.62 ± 15.87	0.700
Diastolic BP	Mean ± SD	86.65 ± 10.53	88.08 ± 10.91	0.660
SpO₂	Mean ± SD	98.63 ± 0.49	98.69 ± 0.48	0.658
RBG (mg/dL)	Mean ± SD	170.23 ± 25.73	198.85 ± 34.39	0.012*
Serum creatinine (mg/dL)	Mean ± SD	0.99 ± 0.32	1.00 ± 0.18	0.849
CrCl (mL/min)	Mean ± SD	129.10 ± 11.98	129.00 ± 15.04	0.982
Hb (g/dL)	Mean ± SD	13.30 ± 0.81	12.56 ± 1.38	0.080
HbA1c (%)	Mean ± SD	7.19 ± 0.71	8.59 ± 1.71	0.012*
Cholesterol (mg/dL)	Mean ± SD	178.48 ± 19.51	181.92 ± 22.51	0.604
LDL (mg/dL)	Mean ± SD	126.00 ± 17.27	151.62 ± 35.91	0.025*
HDL (mg/dL)	Mean ± SD	37.10 ± 4.25	36.83 ± 3.62	0.807
TGs (mg/dL)	Mean ± SD	145.27 ± 20.46	167.31 ± 21.97	0.004*
FBG (mg/dL)	Mean ± SD	96.98 ± 12.35	124.77 ± 34.62	0.014*
TyG index	Mean ± SD	8.84 ± 0.20	9.21 ± 0.26	<0.001*
Ejection fraction (%)	Mean ± SD	50.91 ± 6.11	43.77 ± 4.53	<0.001*

BP, blood pressure; CrCl, creatinine clearance; FBG, fasting blood glucose; Hb, haemoglobin; HbA1c, glycated haemoglobin; HDL, high-density lipoprotein; HR, heart rate; LDL, low-density lipoprotein; RBG, random blood glucose

* Significant

RBG (A), HbA1c (B), LDL (C), TGs (D), FBG (E), TyG index (F) and EF (G) by reflow status. FBG, fasting blood glucose; HbA1c, glycated haemoglobin; LDL, low-density lipoprotein; RBG, random blood glucose; TyG, triglyceride–glucose

Table 3

Angiographic characteristics and procedural details according to reflow status

		Reflow (n = 124)	No-reflow (n = 13)	p-value
Ischaemic changes present	n (%)	104 (83.87)	11 (84.62)	1.000
Affected vessel—LAD	n (%)	73 (58.87)	8 (61.54)	1.000
Affected vessel—LCX	n (%)	31 (25.00)	3 (23.08)
Affected vessel—RCA	n (%)	20 (16.13)	2 (15.38)
Dominance—Co-dominant	n (%)	25 (20.16)	3 (23.08)	0.898
Dominance—LCX	n (%)	12 (9.68)	1 (7.69)
Dominance—RCA	n (%)	87 (70.16)	9 (69.23)
Stenosis 80%	n (%)	1 (0.81)	0 (0.00)	0.001*
Stenosis 85%	n (%)	8 (6.45)	0 (0.00)
Stenosis 90%	n (%)	110 (88.71)	8 (61.54)
Stenosis 95%	n (%)	5 (4.03)	5 (38.46)
Pre-PCI TIMI 1	n (%)	1 (0.81)	0 (0.00)	0.768
Pre-PCI TIMI 2	n (%)	31 (25.00)	4 (30.77)
Pre-PCI TIMI 3	n (%)	92 (74.19)	9 (69.23)
Pre-dilatation	n (%)	45 (36.29)	13 (100.00)	<0.001*
Number of stents = 1	n (%)	62 (50.00)	3 (23.08)	0.064
Number of stents = 2	n (%)	62 (50.00)	10 (76.92)
Post-PCI TIMI 2	n (%)	0 (0.00)	13 (100.00)	<0.001*
Post-PCI TIMI 3	n (%)	124 (100.00)	0 (0.00)
Stent diameter	Median (IQR)	3 (2.5–3)	3 (2.63–3.13)	0.626
Stent length	Median (IQR)	24 (20.5–32)	30 (23–34.5)	0.292

IQR, interquartile range; LAD, left anterior descending; LCX, left circumflex; PCI, percutaneous coronary intervention; RCA, right coronary artery; TIMI, Thrombolysis in Myocardial Infarction

* Significant

Table 4

ROC analysis of metabolic laboratory parameters for predicting the no-reflow phenomenon

Parameter	AUC	SE	p-value	95% CI
TyG index	0.870	0.059	<0.001	0.753–0.987
RBG (mg/dL)	0.761	0.067	0.002	0.629–0.893
HbA1c	0.770	0.088	0.001	0.597–0.943
Cholesterol (mg/dL)	0.564	0.093	0.447	0.382–0.746
LDL (mg/dL)	0.755	0.105	0.003	0.550–0.960
HDL (mg/dL)	0.500	0.078	0.997	0.348–0.653
TGs (mg/dL)	0.772	0.078	0.001	0.619–0.925
FBG (mg/dL)	0.808	0.069	<0.001	0.673–0.943

[i] AUC, area under the curve; CI, confidence interval; FBG, fasting blood glucose; HbA1c, glycated haemoglobin; HDL, high-density lipoprotein; LDL, low-density lipoprotein; RBG, random blood glucose; ROC, receiver operating characteristic; SE, standard error.

Area under ROC curves for predicting reflow. FBG, fasting blood glucose; HDL, high-density lipoprotein; LDL, low-density lipoprotein; RBG, random blood glucose; ROC, receiver operating characteristic; TyG, triglyceride–glucose

Optimising cutoff for TyG index by Youden index. TyG, triglyceride–glucose

Table 5

Multivariable logistic regression for predicting the no-reflow phenomenon

Model	Variable	β	SE	p-value	OR (95% CI)
Parsimonious (primary)	TyG index (per 0.1-unit)	0.717	0.247	0.004*	2.05 (1.26–3.32)
	Duration of diabetes (yr)	0.353	0.134	0.008*	1.42 (1.10–1.85)
	Ejection fraction (%)	−0.280	0.119	0.019*	0.76 (0.60–0.95)
Full (sensitivity)	TyG index (per 0.1-unit)	0.833	0.377	0.027*	2.30 (1.10–4.82)
	Ejection fraction (%)	−0.483	0.221	0.029*	0.62 (0.40–0.95)
	Duration of diabetes (yr)	0.582	0.254	0.022*	1.79 (1.09–2.94)
	Degree of stenosis (%)	0.586	0.333	0.078	1.80 (0.94–3.45)
Age, sex, BMI, smoking, HTN, dyslipidaemia, known IHD		—	—	>0.16 (NS)	—

BMI, body mass index; CI, confidence interval; HTN, hypertension; IHD, ischaemic heart disease; NS, not significant; OR, odds ratio; SE, standard error; TyG, triglyceride–glucose

Pre-dilatation was excluded from both models: all 13 no-reflow events occurred in pre-dilated patients (complete separation), precluding stable estimation

* Significant

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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.

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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

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