Association of the TyG Index, Cardiometabolic Index, and Epicardial Adipose Tissue With Coronary Artery Disease

ABSTRACT Objectives Metabolic dysregulation and adiposity‐related alterations contribute to coronary atherosclerosis, yet the interrelations among cardiometabolic markers and epicardial adipose tissue index (EATi) remain unclear. This study aimed to investigate the associations of the triglyceride–glucose (TyG) index, cardiometabolic index (CMI), and EATi with coronary artery disease (CAD), and to explore potential metabolic–adiposity pathways. Methods A total of 120 patients with CAD and 60 age‐ and sex‐matched controls were included. Clinical and biochemical data were collected. The TyG index and CMI were calculated, and EAT volume (EATV) was quantified by coronary computed tomography angiography (CCTA) and indexed to body surface area (EATi). Associations among variables were assessed using correlation analysis and multivariable logistic regression. Mediation and receiver operating characteristic (ROC) analyses were performed to assess potential pathways and diagnostic performance. Results Fasting glucose, systolic blood pressure, triglycerides, TyG, CMI, and EATi were significantly higher in the CAD group (all p  < 0.05). TyG (OR = 2.688, p  = 0.002), CMI (OR = 3.339, p  = 0.005), and EATi (OR = 2.284, p  = 0.002) were independently associated with CAD. Mediation analysis demonstrated a significant indirect effect via CMI, whereas no mediation effect was observed for EATi. Combined assessment of TyG, CMI, and EATi demonstrated improved diagnostic performance for CAD (AUC = 0.847). Conclusion The combined evaluation of TyG, CMI, and EATi improves the identification of CAD. CMI mediates the association between TyG and CAD, while EATi independently contributes to CAD risk, suggesting distinct metabolic and adiposity‐related mechanisms.