Predictive value of the stress hyperglycemia ratio in patients with acute ST-segment elevation myocardial infarction: insights from a multi-center observational study

Abstract

Background Stress hyperglycemia is a strong predictor of adverse outcomes in patients with acute myocardial infarction (AMI). Recently, the stress hyperglycemia ratio (SHR) has been designed as an index to identify acute hyperglycemia with true risk; however, data regarding the impact of SHR on the prognosis of ST-segment elevation myocardial infarction (STEMI) remains limited. This study aimed to evaluate the predictive value of the SHR in patients with acute STEMI and to assess whether it can improve the predictive efficiency of the Thrombolysis in Myocardial Infarction (TIMI) risk score. Methods This study included 7476 consecutive patients diagnosed with acute STEMI across 274 emergency centers. After excluding 2052 patients due to incomplete data, 5417 patients were included in the final analysis. Patients were divided into three groups according to SHR tertiles (SHR1, SHR2, and SHR3) and were further categorized based on diabetes status. All patients were followed up for major cardiovascular adverse events (MACEs) and all-cause mortality. Results After 30 days of follow-up, 1547 MACEs (28.6%) and 789 all-cause deaths (14.6%) occurred. The incidence of MACEs was highest among patients in the SHR3 group with diabetes mellitus (DM) (42.6%). Kaplan–Meier curves demonstrated that patients with SHR3 and DM also had the highest risk for MACEs when compared with other groups (p < 0.001). Moreover, C-statistics improved significantly when SHR3 was added into the original model: the ΔC-statistics (95% confidence interval) were 0.008 (0.000–0.013) in the total population, 0.010 (0.003–0.017) in the DM group, and 0.007 (0.002–0.013) in the non-DM group (all p < 0.05). In the receiver operating characteristic analysis, the area under the curve (AUC) for the original TIMI risk score for all-cause death was 0.760. When an SHR3 value of 1 point was used to replace the history of DM, hypertension, or angina in the original TIMI risk score, the Delong test revealed significant improvements in the AUC value (∆AUC of 0.009, p < 0.05), especially in the DM group (∆AUC of 0.010, p < 0.05). Conclusion The current results suggest that SHR is independently related to the risks of MACEs and mortality in patients with STEMI. Furthermore, SHR may aid in improving the predictive efficiency of the TIMI risk score in patients with STEMI, especially those with DM.

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

“…Sia et al found that SHR is an independent predictor of one-year mortality in patients with ST-segment elevation myocardial infarction (STEMI) with and without diabetes mellitus [ 27 ]. 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 ].…”

“…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.…”

Association of stress induced hyperglycemia with angiographic findings and clinical outcomes in patients with ST-elevation myocardial infarction

“…Emerging evidence outlines the strong and independent association of SIH with short- and long-term clinical outcomes in STEMI patients irrespective of the definition used for the diagnosis of SIH [ 3 , 5 , 25 , 26 ]. However, the exact mechanisms of this correlation are not fully understood.…”

“…SIH is associated with increased short and long term major adverse cardiovascular events in patients with STEMI irrespective of the presence of diabetes [ 3 – 5 ]. However, the metabolic milieu in which SIH emerges during epicardial coronary artery thrombosis remains poorly understood.…”

Correlation between Carbonic Anhydrase Isozymes and the Evolution of Myocardial Infarction in Diabetic Patients

“…Hyperglycemia is an important factor that determines endothelial dysfunction, leading to vascular damage and microvascular obstructions, and its effect of increasing oxidative stress, inflammation and platelet aggregation is also known. Thus, hyperglycemia causes a change in protein synthesis, with increased expression of pro-inflammatory factors (IL11, IL 6, TNF alpha, fibrinogen), oxidative stress and adhesion molecules (ICAM 1, VCAM 1), all of which result in endothelial damage and the appearance of atherosclerotic lesions [ 9 , 10 ].…”