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

Abstract

Background Stress hyperglycemia ratio (SHR) is significantly related to adverse cardiovascular clinical outcomes and increased in-hospital mortality. However, the relationship between SHR and coronary artery disease (CAD) severity has hitherto not been reported. This study sought to clarify the relationship between the SHR and CAD severity of individuals with different glucose metabolic statuses. Methods A retrospective analysis was performed on 987 patients who underwent coronary angiography (CAG) from October 2020 to May 2022. Based on CAG results, patients were divided into single-vessel CAD and multi-vessel CAD groups. All subjects were stratified into three groups according to the tertiles of the SHR (T1 group: SHR < 0.930; T2 group: 0.930 ≤ SHR < 1.154; T3 group: 1.154 ≤ SHR). Moreover, according to glucose metabolism status, study subjects were divided into normal glucose regulation (NGR), pre-diabetes mellitus (pre-DM) and diabetes mellitus (DM) groups. Finally, the correlation between SHR and CAD severity was analyzed by logistic regression analysis and receiver operating characteristic (ROC) curve. Results The results showed significantly higher SHR in the multi-vessel CAD group than in the single-vessel group. Logistic regression analysis showed that SHR was an independent risk factor for multi-vessel CAD when used as a continuous variable (OR, 4.047; 95% CI 2.137–7.663; P < 0.001). After adjusting for risk factors, the risk of multi-vessel CAD in the T2 and T3 groups was 1.939-fold (95% CI 1.341–2.804; P < 0.001) and 1.860-fold (95% CI 1.272–2.719; P = 0.001) higher than in the T1 group, respectively. The area under the curve (AUC) of ROC plots was 0.613 for SHR. In addition, SHR was significantly correlated with an increased risk of multi-vessel CAD in the pre-DM and DM groups. Conclusions Our study indicated that SHR was significantly correlated with the risk of multi-vessel CAD and predicted CAD severity, especially in pre-DM and DM patients.

Development and Validation of a Nomogram for Predicting the Severity of Coronary Artery Disease Based on Cardiopulmonary Exercise Testing

“…This study identified that, alongside CPET parameters, factors like age, HDL levels, hypertension, and diabetes mellitus independently predict intermediate-high SS in CAD patients. The OR for age was 1.053, consistent with findings reported by Zhang et al 25 Notably, HDL emerges as a protective factor against CAD, indicating that lower HDL levels in CAD patients may correlate with more severe disease, 26 , 27 echoing prior research on the significant impact of abnormal lipid metabolism on CAD progression. 28 Additionally, hypertension and hyperglycemia are well-established risk factors for adverse cardiovascular events.…”

Stress hyperglycemia ratio as a prognostic indicator for long-term adverse outcomes in heart failure with preserved ejection fraction

“…Furthermore, our study revealed that patients with high SHR and low LVEF had a worse prognosis compared to other groups. This observation is supported by several studies where SHR was correlated with worse LV mechanics, myocardial damage, and disease severity [ 18 , 22 , 36 ]. This evidence implies that elevated SHR might play a pivotal role in the core pathological mechanisms of HFpEF, potentially serving as an indicator of disease severity.…”

High triglyceride-glucose index and stress hyperglycemia ratio as predictors of adverse cardiac events in patients with coronary chronic total occlusion: a large-scale prospective cohort study

“…Interestingly, the association with the SHR seems to be different in CHD patients with differing glycaemic status (NG, prediabetes, and T2DM). Zhang et al conducted a retrospective cohort with 987 CHD patients and reported that a high SHR correlated with the improved risk of multivessel CHD in the prediabetes and DM groups, but this correlation was not significant in patients with NG [ 8 ]. Similar to Zhang’s study, we also determined that the predictive value of the SHR for poor prognosis in patients with CTO lesions was especially significant in those with prediabetes and T2DM.…”