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Observational Study
. 2024 Jun 1;23(1):190.
doi: 10.1186/s12933-024-02286-z.

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

Zheng Qiao #  1   2 , Xiaohui Bian #  1   2 , Chenxi Song  1   2 , Rui Zhang  1   2 , Sheng Yuan  1   2 , Zhangyu Lin  1   2 , Chenggang Zhu  1   2 , Qianqian Liu  2 , Wenjun Ma  3 , Kefei Dou  4   5   6
Affiliations
Observational Study

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

Zheng Qiao et al. Cardiovasc Diabetol. .

Abstract

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.

Keywords: Coronary artery disease; Coronary three-vessel disease; Prognosis; Stress hyperglycemia ratio.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flowchart
Fig. 2
Fig. 2
Kaplan–Meier analysis for the cumulative incidence of clinical outcomes according to SHR groups.  A CV events B Cardiac death C Non-fatal MI.  CV events cardiovascular events, SHR stress hyperglycemia ratio
Fig. 3
Fig. 3
RCS curves for the association of SHR with the risk of clinical outcome.  A CV events B Cardiac death C Non-fatal MI.  CV events cardiovascular events, SHR stress hyperglycemia ratio, RSC restricted cubic spline
Fig. 4
Fig. 4
Hazard rations (95% CI) for CV events according to SHR groups and DM status.  CV events cardiovascular events, SHR stress hyperglycemia ratio, DM Diabetes mellitus. Adjusted for age, male sex, BMI, hypertension, AMI, previous MI, previous PCI, previous CABG, smoking status, previous stroke, LVEF, TC, LDL-C, hsCRP, serum creatinine, preprocedural SYNTAX score, calcification, total stent length, aspirin use, clopidogrel use and statins use
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