Objective:

To investigate the association between CTI and the risk of cardiovascular adverse events in patients with STEMI, highlighting its potential value as a prognostic biomarker in clinical practice.

Key Findings:

• 22.5% of patients experienced MACE during follow-up, indicating a significant risk in this population.
• CTI was an independent predictor of MACE (HR = 1.443, 95% CI: 1.191–1.748, P < 0.001), underscoring its clinical relevance.
• The association between CTI and MACE was primarily driven by acute heart failure events, suggesting a critical area for intervention.
• Consistent associations between CTI and MACE were observed regardless of diabetes status, indicating its broad applicability.

Interpretation:

CTI serves as an independent predictor of MACE in STEMI patients undergoing PCI, particularly linked to acute heart failure events.

Limitations:

• Retrospective design may introduce bias, and the single-center study limits generalizability.
• Potential confounding factors not addressed could affect the results.

Conclusion:

CTI is a significant prognostic biomarker for MACE in STEMI patients post-PCI, primarily associated with acute heart failure, warranting further investigation into its clinical utility.