Stress Hyperglycemia Drives the Risk of Hospitalization for Chest Pain in Patients With Ischemia and Nonobstructive Coronary Arteries (INOCA)

Mone, Pasquale; Lombardi, Angela; Salemme, Luigi; Cioppa, Angelo; Popusoi, Grigore; Varzideh, Fahimeh; Pansini, Antonella; Jankauskas, Stanislovas S.; Forzano, Imma; Avvisato, Roberta; Wang, Xujun; Tesorio, Tullio; Santulli, Gaetano

doi:10.2337/dc22-0783

Cited by 26 publications

(14 citation statements)

References 40 publications

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“…Numerous clinical studies have also indicated a link between SHR and unfavorable outcomes in AMI patients [21,22,35,36]. Pasquale et al also found that SHR significantly increases the risk of rehospitalization among 2,874 patients with ischemia with non-obstructive coronary arteries [37]. Given that SHR was used as an indicator for predicting future clinical events in patients with cardiovascular disease, it is still unclear whether it can effectively predict the risk of clinical outcomes in the MINOCA population.…”

Section: Discussionmentioning

confidence: 99%

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

Abdu

Galip

et al. 2023

Cardiovasc Diabetol

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Background Stress hyperglycemia ratio (SHR) is a novel biomarker of true acute hyperglycemia condition and is associated with a worse prognosis in patients with myocardial infarction (MI). However, the effects of SHR in the setting of MI with non-obstructive coronary arteries (MINOCA) have not been investigated. This study aimed to explore the association between SHR and long-term clinical outcomes among MINOCA patients. Methods A total of 410 MINOCA patients were included in the final analysis of this study. The patients were divided into three groups based on the SHR tertiles: [SHR1 group (SHR ≤ 0.73), (n = 143); SHR2 group (SHR 0.73–0.84), n = 131; and SHR3 group (SHR ≥ 0.84), n = 136]. Follow-up for major adverse cardiovascular events (MACE) was conducted on all patients. Cox regression and Kaplan–Meier curve analysis were used to evaluate the relationship between SHR and MACE. The receiver operating curve (ROC) analysis was applied to obtain the optimal cut-off value of SHR for predicting clinical MACE. Results A total of 92 patients developed MACE during the mean 34 months of follow-up. A significant increase in MACE was observed in the SHR3 group compared to the SHR1 and SHR2 groups (35.3% vs. 15.4% and 16.8%, respectively; P < 0.001). The Kaplan–Meier curves demonstrate that SHR3 patients had the highest MACE risk compared to SHR1 and SHR2 patients (log-rank P < 0.001). In addition, when both SHR tertiles and diabetes status were considered, those with SHR3 and diabetes had the highest hazard of MACE (log-rank P < 0.001). Multivariate Cox regression analysis showed that the SHR3 is associated with a 2.465-fold increase in the risk of MACE (adjusted HR, 2.465; 95% CI 1.461–4.159, P = 0.001). The ROC curve analysis showed that the optimal SHR cut-off value for predicting clinical MACE among MINOCA was 0.86. Conclusion Our data indicates, for the first time, that SHR is independently associated with poor long-term prognosis in patients suffering from MINOCA. The optimal SHR cut-off value for predicting clinical MACE among MINOCA patients was 0.86. These findings suggest that SHR may play a potential role in the cardiovascular risk stratification of the MINOCA population.

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Section: Discussionmentioning

confidence: 99%

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

Abdu

Galip

et al. 2023

Cardiovasc Diabetol

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“…The study by Mone et al . [ 24 ] showed that the risk of re-hospitalization with chest pain is significantly increased in patients with ischemia and nonobstructive coronary arteries who have a SHR > 1 for 1 year, suggesting that the SHR may be used as an independent risk factor for these patients. Additionally, the SHR has been identified as a potential predictor for death in patients with MI, especially in those without DM [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Stress hyperglycemia ratio: an independent predictor for in-hospital major adverse cardiovascular and cerebrovascular events in patients with st-segment elevation myocardial infarction

Zhu

Liu

2023

BMC Cardiovasc Disord

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Background To assess the predictive accuracy of the stress hyperglycemia ratio (SHR) for in-hospital major adverse cardiovascular and cerebrovascular events (MACCE) in patients with ST-segment elevation myocardial infarction (STEMI). Methods A total of 1,944 patients were enrolled within 24 h of a new STEMI diagnosis. The SHR was obtained by dividing the blood glucose level at admission by the estimated average glucose. MACCE were defined as acute cerebral infarction, mechanical complications of myocardial infarction, cardiogenic shock, and all-cause death. Patients were then categorized into the MACCE and non-MACCE groups according to the occurrence of in-hospital MACCE. Propensity score matching was used to balance confounding factors, and logistic regression was used to identify the potential predictive factors for MACCE. Results A total of 276 patients were included after 1:1 matching, and the confounding factors were balanced between the two groups. The SHR was an independent predictor of in-hospital MACCE (odds ratio = 10.06, 95% confidence interval: 4.16–27.64, P < 0.001), while blood glucose at admission was not. The SHR was also an independent predictor for in-hospital MACCE in nondiabetic patients with STEMI (odds ratio = 11.26, 95% confidence interval: 3.05–55.21, P < 0.001). Conclusion SHR is an independent predictor of in-hospital MACCE in patients with acute STEMI, especially in nondiabetic patients.

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“…Yang et al (34) noted that the increase in the stress hyperglycemia plays an important role in predicting poor prognosis of patients with coronary heart disease undergoing percutaneous coronary intervention. For angina patients diagnosed as ischemia with nonobstructive coronary arteries, SHR at admission can significantly increase the risk of rehospitalization for chest pain (35). Given that the essence of coronary heart disease is atherosclerosis, it further suggests that the increase in the stress hyperglycemia may be involved in the rupture of atherosclerotic plaques and lead to hospital reinfarction for stroke patients.…”

Section: Discussionmentioning

confidence: 99%

Elevated stress hyperglycemia and the presence of intracranial artery stenosis increase the risk of recurrent stroke

Wang

Fan²,

Duan³

et al. 2023

Front. Endocrinol.

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BackgroundStress hyperglycemia has served as a reliable biomarker to predict poor outcomes after ischemic stroke. However, recent studies have reported some contrary conclusions. Different stroke subtypes may respond inconsistently to stress hyperglycemia. The progression of intracranial atherosclerotic stenosis (ICAS) is tightly related to hyperglycemia. Thus, this study aims to determine the relationship between stress hyperglycemia and recurrent stroke in ischemic stroke patients with or without intracranial atherosclerotic stenosis.MethodsThis is a multicenter retrospective observational cohort study. Patients with acute minor ischemic stroke and eligible computed tomography and magnetic resonance imaging data were enrolled. The severity of stress hyperglycemia is measured by the stress hyperglycemia ratio (SHR). SHR was calculated based on fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) levels. The primary outcome was stroke recurrence during hospitalization. The interaction of SHR levels with the presence of ICAS on the primary outcome was investigated using univariable and multivariable Cox proportional hazards models. Restricted cubic splines were applied to determine the nonlinear relationship between SHR and primary outcome. A two-piecewise linear regression model was used to identify the threshold of SHR.ResultsA total of 610 participants were included in the study. The average age of the patients was 61.4 ± 12.9 years old, and approximately 70% of participants were males. A total of 189 (30.98%) patients had ICAS. The patients were categorized into 3 groups based on the tertiles of SHR. Compared with the group with a lower SHR, a higher SHR was significantly associated with the risk of stroke recurrence in the ICAS group (hazard ratio [HR], 8.52, 95% confidence interval [CI], 3.16-22.96, P<0.001). When SHR was treated as a continuous variable, each 0.1-unit increase in SHR in the ICAS group was associated with a 1.63-fold increase in the risk of recurrence (HR, 1.63, 95% CI, 1.39-1.9, P<0.001) with a threshold of 0.75. FPG but not HbA1c was associated with stroke recurrence in ICAS patients (HR, 1.17, 95% CI, 1.08-1.26, P<0.001). Sensitive analyses showed consistent results after adjusting for previous diabetes mellitus, oral hypoglycemic agents and insulin injection.ConclusionsSHR represents a better biomarker to predict the risk of stroke recurrence in patients with ICAS than FPG and HbA1c regardless of previous diabetes mellitus.Trial registrationhttps://www.chictr.org.cn/showproj.aspx?proj=125817; Identifier, [ChiCTR2100046958].

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Stress Hyperglycemia Drives the Risk of Hospitalization for Chest Pain in Patients With Ischemia and Nonobstructive Coronary Arteries (INOCA)

Cited by 26 publications

References 40 publications

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

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

Stress hyperglycemia ratio: an independent predictor for in-hospital major adverse cardiovascular and cerebrovascular events in patients with st-segment elevation myocardial infarction

Elevated stress hyperglycemia and the presence of intracranial artery stenosis increase the risk of recurrent stroke

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