Association of stress hyperglycemia ratio with intracoronary thrombus burden in diabetic patients with ST-segment elevation myocardial infarction

Abstract

Background: Large intracoronary thrombus burden is not rare during primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Stress hyperglycemia is independently associated with poor prognosis. However, the underlying relationship between stress hyperglycemia and thrombus burden remains unknown. This study aims to investigate the association of stress hyperglycemia, evaluated by the combination of acute and chronic glycemic levels, with intracoronary thrombus burden in diabetic patients with STEMI. Methods: We enrolled 227 consecutive diabetic patients with STEMI undergoing primary PCI within 12 hours after symptom onset. Stress hyperglycemia was estimated using the stress hyperglycemia ratio (SHR), which was calculated as admission glycemia divided by estimated average glucose derived from glycosylated hemoglobin. Based on reclassified angiographic thrombolysis in myocardial infarction (TIMI) thrombus grades, patients were divided into small thrombus burden (STB) group (TIMI thrombus grades <4) and large thrombus burden (LTB) group (TIMI thrombus grades 4 or 5). Results: Of the entire study population, 77 (33.9%) patients were categorized as LTB group, whereas 150 (66.1%) patients presented with STB. The mean age was 64.1 years, and 80.6% of the patients were male. The SHR levels were significantly higher in patients with LTB than in those with STB [1.31; interquartile range (IQR): 1.13-1.48 versus 1.11; IQR: 0.96-1.32; P<0.001]. The predictive performance of SHR for LTB was moderate (area under the curve: 0.669; 95% confidence interval: 0.604-0.730; P<0.001), with the best cut-off value 1.19 (sensitivity 71.4%, specificity 64.7%). The incidence of LTB with SHR ≥1.19 was significantly higher compared with SHR <1.19 (50.9% versus 18.5%; P<0.001). Based on the multivariable logistic regression analysis, the high SHR (≥1.19) was found to be an independent predictor of LTB following adjustment for baseline clinical confounders. Conclusions: A high SHR value was independently associated with large thrombus burden and has a better predictive value than glycemia at admission in diabetic patients with STEMI undergoing primary PCI.Stress hyperglycemia may play an important role on the intracoronary thrombus formation.

A comparison of the stress hyperglycemia ratio, glycemic gap, and glucose to assess the impact of stress‐induced hyperglycemia on ischemic stroke outcome

“…A number of studies in both ischemic stroke and other patient cohorts are consistent with this. 12,[14][15][16][17]21,22 Future interventional studies need to acknowledge and incorporate this in their design.…”

“…threshold of 1.19 best distinguished between large or small thrombus burden in diabetic patients with STsegment elevation myocardial infarction. 16,17 In light of the results from the SHINE study 13 and the emerging role of SHR and GG to accurately reflect the presence of SIH, it is important to assess stroke outcome against specific biomarkers of SIH other than glucose. This study investigated the relationship between SHR and GG with stroke outcome at hospital discharge, both as continuous variables and at nominated thresholds.…”

3-year mortality after acute myocardial infarction in patients with different diabetic status

“…[6] Elevated stress hyperglycemia level may contribute to the formation of intracoronary thrombus and has been identified as a better predictive value than admission blood glucose levels. [29] Strategies to balance ischemic events and bleeding complications still require further investigation. [30] Similarly to previous studies [17,18], our results showed that cardiogenic shock was more common in DM and transient hyperglycemia patients.…”

Association Between Stress Hyperglycemia Ratio and In-hospital Outcomes in Elderly Patients With Acute Myocardial Infarction

“…Moreover, acute fluctuations in glucose levels are associated with increased plaque instability, infarct size, and worse heart function (26), which may also lead to worse prognosis. Also, recent studies reported that stress hyperglycemia was positively associated with in intracoronary thrombus burden and no-reflow phenomenon, which may further explain the significantly higher incidence of mortality and cardiogenic shock in high SHR group (27,28).…”