Impact of stress hyperglycemia ratio on mortality in patients with critical acute myocardial infarction: insight from american MIMIC-IV and the chinese CIN-II study

Abstract

Background Among patients with acute coronary syndrome and percutaneous coronary intervention, stress hyperglycemia ratio (SHR) is primarily associated with short-term unfavorable outcomes. However, the relationship between SHR and long-term worsen prognosis in acute myocardial infarction (AMI) patients admitted in intensive care unit (ICU) are not fully investigated, especially in those with different ethnicity. This study aimed to clarify the association of SHR with all-cause mortality in critical AMI patients from American and Chinese cohorts. Methods Overall 4,337 AMI patients with their first ICU admission from the American Medical Information Mart for Intensive Care (MIMIC)-IV database (n = 2,166) and Chinese multicenter registry cohort Cardiorenal ImprovemeNt II (CIN-II, n = 2,171) were included in this study. The patients were divided into 4 groups based on quantiles of SHR in both two cohorts. Results The total mortality was 23.8% (maximum follow-up time: 12.1 years) in American MIMIC-IV and 29.1% (maximum follow-up time: 14.1 years) in Chinese CIN-II. In MIMIC-IV cohort, patients with SHR of quartile 4 had higher risk of 1-year (adjusted hazard radio [aHR] = 1.87; 95% CI: 1.40–2.50) and long-term (aHR = 1.63; 95% CI: 1.27–2.09) all-cause mortality than quartile 2 (as reference). Similar results were observed in CIN-II cohort (1-year mortality: aHR = 1.44; 95%CI: 1.03–2.02; long-term mortality: aHR = 1.32; 95%CI: 1.05–1.66). In both two group, restricted cubic splines indicated a J-shaped correlation between SHR and all-cause mortality. In subgroup analysis, SHR was significantly associated with higher 1-year and long-term all-cause mortality among patients without diabetes in both MIMIC-IV and CIN-II cohort. Conclusion Among critical AMI patients, elevated SHR is significantly associated with and 1-year and long-term all-cause mortality, especially in those without diabetes, and the results are consistently in both American and Chinese cohorts.

A predictive model for acute heart failure after Percutaneous Coronary Intervention in patients with ST-Segment Elevation Myocardial Infarction

“…Man sour et al con rmed that acute hyperglycemia > 7.8 mmol/L on admission was a risk factor for heart failure in patients with ACS [21] , and Side Gao et al showed that stress hyperglycemia was an independent predictor and a risk factor for poor prognosis of acute myocardial infarction in hospitalized patients in their study on 1179 patients with myocardial infarction with nonobstructive coronary arteries [22] . Meanwhile, Liu J et al included overall 4,337 AMI patients with their rst ICU admission from electronic hospital records (EHR) data obtain from one U.S. public critical care databases as well as proprietary real-world EHR dataset from China,elevated SHR is signi cantly associated with and 1-year and long-term all-cause mortality, especially in those without diabetes [23] . This is consistent with the results of this study.…”

The relative and combined ability of stress hyperglycemia ratio and N-terminal pro-B-type natriuretic peptide to predict all-cause mortality in diabetic patients with multivessel coronary artery disease

“…In a study of 6,287 STEMI patients with a follow-up 5 years, Kojima et al (2020) reported that the highest SHR quartile was significantly associated with all-cause death and heart failure admission in non-diabetic patients but not in diabetic patients [ 25 ]. Data from 4337 AMI patients from American and Chinese cohorts with a maximum follow-up time of more than 14 years showed that elevated SHR was significantly associated with 1 year and long-term all-cause mortality in patients without diabetes, but not in those with DM [ 24 ]. The potential reasons for these discrepancies may be attributed to variations in patient characteristics, disease severity, and follow-up among the studies.…”

“…The exact cause of death for patients who died outside our hospital could not be determined. Many studies have investigated the association between SHR and all-cause mortality [ 24 , 44 , 45 ]. Therefore, cardiovascular mortality, nonfatal MI, and nonfatal stroke were not included in this study.…”

The prognostic value of the stress hyperglycemia ratio for all-cause and cardiovascular mortality in patients with diabetes or prediabetes: insights from NHANES 2005–2018

“…In addition to its strong correlation with various diseases, SHR has been used to predict clinical outcomes. In patients with acute myocardial infarction, elevated SHR is significantly associated with long-term all-cause mortality in both American and Chinese cohorts [21]. In patients with acute decompensated heart failure, there was a U-shaped association between SHR and mortality and rehospitalization rates [7].…”