Association of stress hyperglycemia ratio and in-hospital mortality in patients with coronary artery disease: insights from a large cohort study

Abstract

Background Stress hyperglycemia is strongly associated with poor clinical outcomes in patients with acute coronary syndrome (ACS). Recently, the stress hyperglycemia ratio (SHR) has been proposed to represent relative hyperglycemia. Studies regarding the relationship between SHR and mortality in coronary artery disease (CAD) are limited. This study aimed to clarify the association between SHR and in-hospital mortality in patients with CAD. Methods A total of 19,929 patients with CAD who were hospitalized in Beijing Hospital were enrolled in this study. Patients with an estimated glomerular filtration rate < 30 ml/min, cancer, or missing blood glucose/HbA1c data were excluded; therefore, 8,196 patients were included in the final analysis. The patients were divided into three groups based on tertiles of SHR: T1 group (SHR < 0.725, n = 2,732), T2 group (0.725 ≤ SHR < 0.832, n = 2,730), and T3 group (SHR ≥ 0.832, n = 2,734). The primary endpoint was in-hospital mortality. Results The overall in-hospital mortality rate was 0.91% (n = 74). After adjusting for covariates, SHR was significantly associated with in-hospital mortality in patients with CAD [odds ratio (OR) = 17.038; 95% confidence interval (CI) = 9.668–30.027; P < 0.001], and the T3 group had a higher risk of in-hospital mortality (OR = 4.901; 95% CI = 2.583–9.297; P < 0.001) compared with T1 group. In the subgroup analysis, the T3 group had an increased risk of mortality among patients with pre-diabetes mellitus (pre-DM) (OR = 9.670; 95% CI = 1.886–49.571; P = 0.007) and diabetes mellitus (DM) (OR = 5.023; 95% CI = 2.371–10.640; P < 0.001) after adjustments for covariates. The relationship between SHR and in-hospital mortality among patients with ACS and chronic coronary syndrome was consistent with the main finding. SHR and in-hospital mortality exhibited a dose-response relationship, and the risk of in-hospital mortality increased when the SHR index was above 1.20. Moreover, the area under the curve of SHR for predicting in-hospital mortality in patients with CAD was 0.741. Conclusion SHR is significantly associated with in-hospital mortality in patients with CAD. SHR may be an effective predictor of in-hospital mortality in patients with CAD, especially for those with pre-DM and DM.

Association of stress hyperglycemia ratio and poor long-term prognosis in patients with myocardial infarction with non-obstructive coronary arteries

“…A large cohort study in Asia found a correlation between SHR and early and late cardiac outcomes among ACS patients [ 16 ]. An analysis by Xu et al found a significant association between SHR and in-hospital mortality in patients with CAD [ 18 ]. The SHR significantly predicted all-cause mortality among 5841 STEMI patients and 4105 NSTEMI patients after one year of fellow up [ 19 ].…”

“…The best cut-off value of SHR to predict clinical outcomes in CAD patients differs among studies. Among 19,929 patients with CAD, 0.741 was the best cut-off value for SHR to predict clinical outcomes [ 18 ]. An optimal SHR cut-off value of 0.78 predicted poor prognosis in ACS patients [ 16 ].…”

“…Abbott Laboratories (Chicago, IL, USA) was used to calculate the HbA1c. The SHR is calculated using the following equation by dividing admission glucose by the average glucose calculated from HbA1c: SHR = [(admission glucose (mmol/L) / [1.59 × HbA1c (%) − 2.59] [ 18 ].…”

“…In this regard, the stress hyperglycemia ratio (SHR) has been developed as a new marker to reflect true acute hyperglycemia condition, which is estimated based on the acute admission glucose level and the chronic glycemic value [calculated by glycosylated hemoglobin (HbA1c)] [17]. Several clinical studies have reported that SHR is associated with significantly higher in-hospital mortality and longterm MACE than admission glucose in patients with AMI [16,[18][19][20][21][22]. As of yet, there is no data regarding the impact of SHR on the clinical outcomes among MINOCA patients.…”

Association between the stress hyperglycemia ratio and severity of coronary artery disease under different glucose metabolic states

“…Studies have also confirmed that relative hyperglycemia measured by SHR was more associated with critical illness than absolute hyperglycemia and was a better biomarker for critical illness than absolute hyperglycemia [ 12 ]. Moreover, overwhelming evidence substantiates that SHR is significantly related to adverse cardiovascular outcomes and related mortality [ 11 , 13 – 15 ].…”