CRP–TyG index and risk of new‑onset central retinal artery occlusion and subsequent major adverse cardiovascular and cerebrovascular events: a propensity score‑matched cohort study

BACKGROUND: The C‑reactive protein-triglyceride glucose index (CTI), a composite marker of systemic inflammation and metabolic status, has been associated with cardiovascular and cerebrovascular risk. Its role in central retinal artery occlusion (CRAO) and subsequent adverse outcomes is unclear. METHODS: In this cohort study, 122 CRAO patients and 488 matched controls who underwent coronary angiography without coronary artery disease were analyzed. CTI was calculated as 0.412 × ln [CRP (mg/L) + 0.5 × ln [TG × FPG(mg/dL)]. Logistic regression adjusted for demographic, clinical, laboratory, and medication variables was used to explore the relationship between CTI and the risk of CRAO. Restricted cubic spline models assessed the dose-response relationship between CTI and CRAO risk. The primary endpoint was CRAO and the secondary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs) during the 36‑month follow‑up. RESULTS: Higher CTI was independently associated with CRAO (adjusted OR = 1.46, 95% CI 1.14-1.88; P = 0.003). Restricted cubic spline analysis identified a CTI threshold of 9.810. CRAO patients with CTI > 9.810 had a higher incidence of MACCEs (31.1% vs. 10.1%, P < 0.001), particularly acute coronary syndromes (20.3% vs. 7.1%, P < 0.001). In subgroup analysis, CRAO patients with CTI > 9.810 had the highest MACCEs rate (40.0%) and significantly greater risk of all‑cause death, stroke, and acute coronary syndromes (all adjusted P < 0.05) compared with other groups. Time‑to‑event analysis revealed that among all groups, CRAO patients with CTI > 9.810 had the shortest median time to MACCEs occurrence at 6 months (IQR, 4-11). CONCLUSIONS: Elevated CTI is independently associated with increased CRAO risk and predicts higher adverse MACCEs outcomes, suggesting CTI as a potential biomarker for risk stratification and secondary prevention in CRAO patients.