Aim To investigate the relationship between the triglyceride-glucose (TyG) index and major adverse cardiovascular and cerebrovascular events (MACCE) in the acute coronary syndrome(ACS) patients underwent emergency percutaneous coronary intervention (PCI) with drug-eluting stents. Methods Overall, 2 249 patients with ACS underwent emergency PCI were enrolled in this study. The patients were divided into high TyG index group and low TyG index group according to the median TyG index. The incidence of endpoint events as follows:all-cause death, non-fatal myocardial infarction(MI), non-fatal ischemia stroke, and ischemia-driven revascularization were determined and compared between two groups.Unitivariate and multivariate Cox analysis were used to evaluate the predictive value of the TyG index for MACCE. Subgroup analysis was used to evaluate the consistency of the predictive value of the TyG index for MACCE. Results Overall, 299 (13.3%) endpoint events were documented during a 66-month follow-up. Compared with the low TyG index group, the high TyG index group had a significantly higher incidence of MACCE (17.1% vs. 9.5%, P＜0.001), all-cause death (6.2% vs. 3.7%, P＝0.007), cardiac death (4.4% vs. 2.1%, P＝0.002), non-fatal MI (1.0% vs. 0.3%, P＝0.001), non-fatal ischemia stroke (2.0% vs. 1.0%, P＝0.039) and ischemia-driven revascularization (7.8% vs. 4.8%, P＝0.001). The multivariable Cox regression analysis further revealed that the TyG index was an independent predictor of MACCE (hazard ratio (HR)1.0,5% confidence interval (CI) 1.304～2.242,P＜0.001). The results of subgroup analysis showed that the predictive effect of TyG index on MACCE still existed in different subgroups. Conclusion The TyG index might be an independent predictor of MACCE in patients with ACS underwent emergency PCI with drug-eluting stents.