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

OBJECTIVE: In recent years, some studies have indicated that a novel marker described as the stress hyperglycemia ratio (SHR) can reflect the true acute hyperglycemic status and is associated with the short-term poor prognosis in patients with acute myocardial infarction (AMI). The present study evaluated the association of the SHR with adverse cardiovascular events in patients with ACS. <br>RESEARCH DESIGN AND METHODS: We consecutively enrolled 5,562 ACS patients who underwent drug-eluting stent (DES) implantation. All subjects were divided into 5 groups according to the SHR, which was determined by the following formula: ABG/[(28.7 × HbA1c %) － 46.7], where ABG represents the admission blood glucose level. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs) at the two-year follow-up, and the secondary endpoint was major adverse cardiovascular events ((MACEs) at two-year follow-up, cardiac death and nonfatal MI at two-year follow-up, and in-hospital cardiac death and nonfatal MI. <br>RESULTS: A total of 643 MACCEs 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 adjusting for other confounding factors. <br>CONCLUSION: There were U-shaped associations of the SHR with the MACCE rate and MACE rate at two-year follow-ups, and J-shaped associations of the SHR with the in-hospital cardiac death and MI and that at two-year follow-up in ACS patients who underwent DES implantation; and the inflection point of SHR for poor prognosis was 0.78. <a><b></b></a>