Background: Stress hyperglycemia ratio (SHR), a novel biomarker of stress hyperglycemia, was proved to be a reliable predictor of short-term adverse outcomes in patients with acute coronary syndromes (ACS). However, its impact on long-term prognosis remained controversial.
Methods: A total of 7662 patients with ACS from a large nationwide prospective cohort between January 2015 and May 2019 were included. SHR was calculated by the following formula: SHR = admission glucose (mmol/L)/(1.59 × HbA1c [%]-2.59). The primary end point was a major adverse cardiovascular event (MACE) during follow-up, a composite of all-cause death, myocardial infarction, and unplanned revascularization. The second end point was the separate components of the primary end points.
Results: During a median follow-up of 2.1 years, 779 MACE events occurred. After multivariable adjustment, ACS patients with the highest SHR tertile were significantly associated with increased long-term risks of MACE (hazard ratio [HR] 1.53, 95% confidence interval [CI] 1.24-1.88), all-cause death (HR 1.80, 95% CI 1.29-2.51) and unplanned revascularization (HR 1.44, 95% CI 1.09-1.91). Although significant associations between the highest SHR tertile and risks of MACE and all-cause death were assessed in both diabetic and nondiabetic patients, the patterns of risk were different in these two groups.
Conclusion: Elevated SHR was independently associated with a higher risk of long-term outcomes irrespective of diabetic status, suggesting that SHR was a potential biomarker for risk stratification after ACS.
背景:应激性高血糖比率(SHR)是应激性高血糖的一种新型生物标志物, 已被证明是急性冠状动脉综合征(ACS)患者短期不良结果可靠的预测因子。然而, 它对于长期预后的影响仍存在争议。 方法:纳入了2015年1月至2019年5月间全国范围内一项大型前瞻性队列中的7,662名ACS患者。SHR通过以下公式计算得出:SHR = 入院血糖(mmol/L)/ [1.59×糖化血红蛋白(%)-2.59]。主要终点是随访期间发生的主要不良心血管事件(MACE), 包括死亡, 心肌梗死和非计划性血管再通术这些合并症。次要终点是主要终点的各个组成部分。 结果:中位随访时间为2.1年, 发生了779例MACE事件。经多变量调整后, ACS患者中最高SHR三分位数显著与长期MACE风险增加相关(HR 1.53, 95%CI 1.24-1.88), 与全因死亡风险增加相关(HR 1.80, 95%CI 1.29-2.51), 以及与非计划性血管再通术风险增加相关(HR 1.44, 95%CI 1.09-1.91)。尽管无论糖尿病患者还是非糖尿病患者, 最高SHR三分位数与MACE和全因死亡风险之间均存在显著相关性, 但这两个组别的风险模式是不同的。 结论:不论患者是否有糖尿病, 升高的SHR与长期结局的风险增加相关。这表明SHR是ACS后风险分层的潜在生物标志物。.
Keywords: acute coronary syndrome; coronary artery disease; long-term prognosis; stress hyperglycemia ratio; 冠状动脉疾病; 应激性高血糖比值; 急性冠状动脉综合征; 远期预后.
© 2023 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.