Journal Article

High stress hyperglycemia ratio predicts adverse clinical outcome in patients with coronary three-vessel disease: a large-scale cohort study

Ma, Wenjun, Lin, Zhangyu, Dou, Kefei, Qiao, Zheng, Bian, Xiaohui, Song, Chenxi, Liu, Qianqian, Zhang, Rui, Zhu, Chenggang, Yuan, Sheng

2024

Overview

Background Coronary three-vessel disease (CTVD) accounts for one-third of the overall incidence of coronary artery disease, with heightened mortality rates compared to single-vessel lesions, including common trunk lesions. Dysregulated glucose metabolism exacerbates atherosclerosis and increases cardiovascular risk. The stress hyperglycemia ratio (SHR) is proposed as an indicator of glucose metabolism status but its association with cardiovascular outcomes in CTVD patients undergoing percutaneous coronary intervention (PCI) remains unclear. Methods 10,532 CTVD patients undergoing PCI were consecutively enrolled. SHR was calculated using the formula: admission blood glucose (mmol/L)/[1.59×HbA1c (%)–2.59]. Patients were divided into two groups (SHR Low and SHR High) according to the optimal cutoff value of SHR. Multivariable Cox regression models were used to assess the relationship between SHR and long-term prognosis. The primary endpoint was cardiovascular (CV) events, composing of cardiac death and non-fatal myocardial infarction (MI). Results During the median follow-up time of 3 years, a total of 279 cases (2.6%) of CV events were recorded. Multivariable Cox analyses showed that high SHR was associated with a significantly higher risk of CV events [Hazard Ratio (HR) 1.99, 95% Confidence interval (CI) 1.58–2.52, P  < 0.001). This association remained consistent in patients with (HR 1.50, 95% CI 1.08–2.10, P  = 0.016) and without diabetes (HR 1.97, 95% CI 1.42–2.72, P  < 0.001). Additionally, adding SHR to the base model of traditional risk factors led to a significant improvement in the C-index, net reclassification and integrated discrimination. Conclusions SHR was a significant predictor for adverse CV outcomes in CTVD patients with or without diabetes, which suggested that it could aid in the risk stratification in this particular population regardless of glucose metabolism status.

• Publisher: BioMed Central,Springer Nature B.V,BMC
• Subject: Aged / Angiology / Angioplasty / Arteriosclerosis / Atherosclerosis / Biomarkers - blood / Blood clots / Blood Glucose - metabolism / Blood pressure / Body mass index / Cardiology / Cardiovascular disease / Cardiovascular diseases / Cholesterol / Cohort analysis / Coronary artery disease / Coronary Artery Disease - blood / Coronary Artery Disease - diagnosis / Coronary Artery Disease - diagnostic imaging / Coronary Artery Disease - epidemiology / Coronary Artery Disease - mortality / Coronary Artery Disease - therapy / Coronary three-vessel disease / Coronary vessels / Creatinine / Diabetes / Diabetes mellitus / Ejection fraction / Female / Glucose / Glucose metabolism / Glycated Hemoglobin - metabolism / Health risks / Heart attacks / Heart diseases / Heart failure / Hemoglobin / Hospitals / Humans / Hyperglycemia / Hyperglycemia - blood / Hyperglycemia - diagnosis / Hyperglycemia - epidemiology / Hyperglycemia - mortality / Hypertension / Informed consent / Intervention / Ischemia / Male / Medical prognosis / Medicine / Medicine & Public Health / Metabolism / Middle Aged / Mortality / Myocardial infarction / Myocardial Infarction - blood / Myocardial Infarction - diagnosis / Myocardial Infarction - epidemiology / Myocardial Infarction - mortality / Percutaneous Coronary Intervention - adverse effects / Percutaneous Coronary Intervention - mortality / Predictive Value of Tests / Prognosis / Reclassification / Regression analysis / Retrospective Studies / Risk Assessment / Risk Factors / Stress / Stress hyperglycemia ratio / Stroke / Time Factors / Treatment Outcome