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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

posted on 21.01.2022, 15:53 by Jie Yang, Yitian Zheng, Chen Li, Jun Gao, Xiangbin Meng, Kuo Zhang, Wenyao Wang, Chunli Shao, Yi-Da Tang
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.
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.
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.
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.


This work was supported by National Key R&D Program of China (2020YFC2004700), National Natural Science Foundation of China (81825003, 91957123, 81800327, 81900272), and the Beijing Nova Program (Z201100006820002) from Beijing Municipal Science & Technology Commission.