The Impact of the Stress Hyperglycemia Ratio on Short-term and Long-term Poor Prognosis in Patients With Acute Coronary Syndrome: Insight From a Large Cohort Study in Asia

Abstract

OBJECTIVE In recent years, some studies have indicated that a novel marker described as the stress hyperglycemia ratio (SHR) can reflect true acute hyperglycemic status and is associated with the short-term poor prognosis in patients with acute myocardial infarction. In the current study we evaluated the association of SHR with adverse cardiovascular events among patients with acute coronary syndrome (ACS). RESEARCH DESIGN AND METHODS We consecutively enrolled 5,562 ACS patients who underwent drug-eluting stent (DES) implantation. All subjects were divided into five groups according to SHR, which was determined by the following formula: ABG / [(28.7 × HbA1c %) − 46.7], where ABG is admission blood glucose level. The primary end point was major adverse cardiovascular and cerebrovascular events (MACCE) at the 2-year follow-up, and the secondary end point included major adverse cardiovascular events (MACE) at 2-year follow-up, cardiac death, and nonfatal myocardial infarction (MI) at 2-year follow-up and in-hospital cardiac death and nonfatal MI. RESULTS A total of 643 MACCE were recorded during a median follow-up of 28.3 months. Kaplan-Meier survival analysis showed the lowest MACCE incidence in quintile 3 (P < 0.001). Moreover, the outcomes of restricted cubic spline analysis suggested that there was a U-shaped or J-shaped association between the SHR and early and late cardiovascular outcomes even after adjustment for other confounding factors. CONCLUSIONS There were U-shaped associations of SHR with MACCE rate and MACE rate at 2-year follow-ups and J-shaped associations of SHR with in-hospital cardiac death and MI and that at 2-year follow-up in ACS patients who underwent DES implantation, and the inflection point of SHR for poor prognosis was 0.78.

Stress hyperglycemia ratio and in-hospital prognosis in non-surgical patients with heart failure and type 2 diabetes

“…Our study also exhibits U-shaped associations of SHR with in-hospital adverse events in people with type 2 diabetes hospitalized with heart failure, suggesting the nadir range of SHR at 0.79 to 1.08. This is consistent with a recent study that SHR is nonlinearly associated with in-hospital cardiac death and MI in patients with ACS and the inflection point is at SHR of 0.78 [ 9 ]. A prior study in Spain [ 8 ] found the third tertile of SHR with a mean of around 1.2 was associated with the lowest 4 year mortality in people with diabetes hospitalized for acute heart failure, which was in line with our findings to some extent.…”

“…Analysis may be necessary. Finally, like many other studies investigating stressful hyperglycemia [ 4 , 7 , 9 ], since many participants were admitted to the hospital from the emergency room, this study was unable to measure the impact of diet on glucose. It calls for prospective studies to collect information regarding diet intake, intravenous glucose infusion and blood glucose measure.…”

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

“…In an animal model of shock, external highly permeable glucose increased cardiac output and improved survival [ 17 ]. However, several studies have reported that stress hyperglycemia is strongly associated with adverse clinical outcomes among patients with critical illnesses, including myocardial infarction, stroke, sepsis, and COVID-19 [ 11 , 18 , 19 ]. Stress hyperglycemia has been identified as an independent risk factor for worsened prognoses in patients with ACS [ 4 – 6 , 20 ].…”

“…Xu et al reported that SHR was significantly associated with 30-day mortality in patients with STEMI and that the predictive efficiency of the TIMI risk score can be improved after adding SHR as one point [ 12 ]. Yang et al observed a J-shaped relationship between SHR and in-hospital cardiac death in patients with ACS who underwent the implantation of a drug-eluting stent [ 11 ]. Chen et al reported a dose-response relationship between SHR and in-hospital deaths in patients > 75 years of age with acute myocardial infarction [ 28 ].…”

“…The stress hyperglycemia ratio (SHR) represents relative hyperglycemia and has been proven to be effective in predicting worsening prognosis in patients with severe acute disease [ 9 ]. Several studies have reported that SHR was significantly associated with adverse clinical outcomes in patients with ACS [ 11 , 12 ]. However, this association may be a comprehensive effect of a heterogeneous population with ACS.…”