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. 2023 Dec 6;22(1):334.
doi: 10.1186/s12933-023-02061-6.

Impact of stress hyperglycemia ratio, derived from glycated albumin or hemoglobin A1c, on mortality among ST-segment elevation myocardial infarction patients

Wang Liao  1 , Yuwen Chen  2 , Qiyue Gao  2 , Rongrong Gan  1 , Ming Li  1 , Zhenliang Liu  1 , Jiasheng Liang  1 , Henghua Cui  1 , Kaida Ren  2 , Yabin Liu  2 , Zhengdong Wang  3 , Jun Jiang  4 , Qucheng Wei  5
Affiliations

Impact of stress hyperglycemia ratio, derived from glycated albumin or hemoglobin A1c, on mortality among ST-segment elevation myocardial infarction patients

Wang Liao et al. Cardiovasc Diabetol. .

Abstract

Background: Stress hyperglycemia ratio (SHR), associated with adverse outcomes in patients with ST-segment elevation myocardial infarction (STEMI), has several definitions. This study aims to assess the prognostic value of SHR, derived from hemoglobin A1c (HbA1c) or glycated albumin (GA), to mortality.

Methods: The study comprised 1,643 STEMI patients who underwent percutaneous coronary intervention (PCI) in two centers. SHR1 was calculated using fasting blood glucose (FBG)/GA, while SHR2 was calculated using the formula FBG/(1.59*HbA1c-2.59). The primary endpoints were in-hospital death and all-cause mortality, with a median follow-up duration of 1.56 years.

Results: Higher SHR1 and SHR2 values are associated with increased risks of in-hospital death and all-cause mortality. Each standard deviation increase in SHR1 corresponded to a 39% and 22% escalation in in-hospital death and all-cause mortality, respectively. The respective increases for SHR2 were 51% and 26%. Further examinations validated these relationships as linear. Additionally, the areas under the curve (AUC) for in-hospital death were not significantly different between SHR1 and SHR2 (p > 0.05). Incorporating SHR1 or SHR2 into the base model significantly improved the discrimination and risk reclassification for in-hospital and all-cause mortality. A subgroup analysis revealed that the effects of SHR1 and SHR2 were more pronounced in patients with hypercholesteremia.

Conclusion: SHR1 and SHR2 have emerged as robust and independent prognostic markers for STEMI patients undergoing PCI. The SHR calculation based on either HbA1c or GA can provide additional predictive value for mortality beyond traditional risk factors, helping to identify high-risk STEMI patients.

Keywords: Glycated albumin; Glycated hemoglobin A1c; Prognosis; ST-segment elevation myocardial infarction; Stress-induced hyperglycemia.

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Conflict of interest statement

There are no competing interests to declare by the authors.

Figures

Fig. 1
Fig. 1
Association of SHR1 and SHR2 with poor prognosis. A SHR1 and in-hospital death; B SHR2 and in-hospital death; C SHR1 and all-cause mortality; D SHR2 and all-cause mortality
Fig. 2
Fig. 2
ROC curves of SHR1 and SHR2 to predict the in-hospital death in the overall study population. The AUC of SHR1 was 0.675, 95% CI 0.598–0.752; the AUC of SHR2 was 0.705, 95% CI 0.629–0.782 (p = 0.06)
Fig. 3
Fig. 3
Subgroup analyses of SHR1 and SHR2 in different populations. A In-hospital death according to SHR1; B In-hospital death according to SHR2; C All-cause mortality according to SHR1; D All-cause mortality according to SHR2
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References

    1. GBD 2017 Causes of Death Collaborators Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1736–88. doi: 10.1016/S0140-6736(18)32203-7. - DOI - PMC - PubMed
    1. Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023 doi: 10.1093/eurheartj/ehad191. - DOI - PubMed
    1. Tern PJW, Ho AKH, Sultana R, Ahn Y, Almahmeed W, Brieger D, et al. Comparative overview of ST-elevation myocardial infarction epidemiology, demographics, management, and outcomes in five Asia-Pacific countries: a meta-analysis. Eur Heart J Qual Care Clin Outcomes. 2021;7:6–17. doi: 10.1093/ehjqcco/qcaa057. - DOI - PubMed
    1. Vogel B, Claessen BE, Arnold SV, Chan D, Cohen DJ, Giannitsis E, et al. ST-segment elevation myocardial infarction. Nat Rev Dis Primers. 2019;5:39. doi: 10.1038/s41572-019-0090-3. - DOI - PubMed
    1. Lee TF, Drake SM, Roberts GW, Bersten A, Stranks SN, Heilbronn LK, et al. Relative hyperglycemia is an independent determinant of in-hospital mortality in patients with critical illness. Crit Care Med. 2020;48:e115–e122. doi: 10.1097/CCM.0000000000004133. - DOI - PubMed