Introduction: The triglyceride–glucose (TyG) index has been closely associated with a range of cardiovascular diseases. However, the association between the TyG index and left ventricular aneurysm (LVA) formation in patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) remains unknown. Methods: This study recruited 551 patients in the first cohort and 471 patients in the validation cohort. To determine the independent risk factors associated with LVA formation, a multivariable logistic regression analysis was conducted. The predictive capability of both the TyG index and the composite variable for LVA formation was evaluated through the use of ROC curve analysis. Results: The prevalence of LVA was found to be 14.5% in the first cohort and 13.6% in the validation cohort. In both cohorts, a higher TyG index correlated with an increased incidence of LVA (20.5% vs. 8.0%, P < 0.001 in the first cohort; 18.4% vs. 8.6%, P = 0.002 in the validation cohort). The TyG index was consistently elevated in the LVA group in comparison to those without LVA (9.3 ± 0.7 vs. 8.9 ± 0.9, P < 0.001 in the first cohort; 9.4 ± 0.7 vs. 9.0 ± 0.7, P < 0.001 in the validation cohort). Analysis using multivariable logistic regression showed that an independent relationship exists between the TyG index and the risk of LVA in both the first (OR = 4.2, P = 0.004) and validation (OR = 2.11, P = 0.008) cohorts. The applicability of the TyG index in predicting LVA had C statistics of 0.736 for the first cohort and 0.738 for the validation cohort, which surpassed those of triglycerides and fasting plasma glucose. The composite variable consisting of the TyG index, left ventricular ejection fraction, and left anterior descending artery (LAD) as the culprit vessel significantly improved the discriminant power (C statistic = 0.913 in the first cohort and 0.89 in the validation cohort). Discussion: A higher TyG index was independently linked to the development of LVA in patients with acute STEMI who received primary PCI.

Background: Left ventricular aneurysm (LVA) is a major mechanical complication following acute ST-segment elevation myocardial infarction (STEMI). This study aimed to evaluate the predictive ability of the lactate dehydrogenase to albumin ratio (LAR) for the risk of LVA among STEMI patients. Methods: The study was conducted from July 2018 to 2025 across three medical centers in China. The study cohort comprised STEMI patients who underwent primary percutaneous coronary intervention across three medical centers. Multivariate logistic regression analysis and Restricted cubic spline plots were employed to assess the association between different LAR levels and LVA risk. Subgroup analyses were conducted to assess the consistency of the result. Results: The study included 551, 471, and 1384 eligible participants from the first, second, and third cohort, respectively. After adjusting for potential confounders, individuals in the highest quartile of LAR (Q4) demonstrated a significantly elevated risk of developing LVA compared to those in the lowest quartile (Q1) across all cohorts (First cohort: OR = 3.63, 95% CI = 1.65 - 7.96, P = 0.001; Second cohort: OR = 6.01, 95% CI = 2.22 - 16.26, P< 0.001; Third cohort: OR = 2.41, 95% CI = 1.47 - 3.96, P< 0.001). RCS analysis revealed a positive linear association between LAR and the risk of LVA across the three cohorts (overall P> 0.05). The predictive capacity of LAR for assessing LVA risk exceeded that of both lactate dehydrogenase and albumin (P< 0.05). Subgroup analyses further reinforced the robustness of these findings. Conclusion: An elevated LAR was independently associated with an increased risk of LVA development in patients with STEMI who underwent primary PCI.