Diagnostic value of triglyceride-rich lipoprotein cholesterol for coronary artery lesions and its predictive significance for long-term prognosis in elderly patients with coronary heart disease

Objective: To assess the diagnostic and prognostic value of triglyceride-rich lipoprotein cholesterol (TRL-C) in patients with coronary artery disease in the elderly. Methods: This study enrolled 220 patients with coronary artery disease in the elderly undergoing coronary angiography at Tianjin Chest Hospital (January-December 2020) with a four-year follow-up. Coronary lesions were classified as mild (SYNTAX score 1-22) or moderate-to-severe (score ≥23). Logistic regression analyzed TRL-C's association with lesion severity, while Cox regression evaluated its predictive capacity for all-cause mortality. Results: For coronary lesion severity prediction, TRL-C-based models achieved AUCs of 0.76 (95% CI: 0.68-0.85) and 0.77 (95% CI: 0.64-0.90) in training and validation sets, respectively, with decision curve analysis (DCA) confirming clinical utility. For all-cause mortality prediction, models demonstrated higher discriminative performance, with training and validation AUCs of 0.94 (95% CI: 0.89-0.99) and 0.92 (95% CI: 0.86-0.99), respectively, supported by favorable DCA results. Conclusion: TRL-C strongly predicts both coronary lesion severity and long-term mortality in patients with coronary artery disease in the elderly, offering a potential biomarker for risk stratification and personalized management.