Impact of stress hyperglycemia ratio on mortality in patients with critical acute myocardial infarction: insight from american MIMIC-IV and the chinese CIN-II study

Jin Liu; Yang Zhou; Haozhang Huang; Rui Liu; Yu Kang; Tingting Zhu; Jielan Wu; Yuwei Gao; Yuqi Li; Chenyang Wang; Shiqun Chen; Nianjin Xie; Xueyan Zheng; Ruilin Meng; Yong Liu; Ning Tan; Fei Gao

doi:10.1186/s12933-023-02012-1

Impact of stress hyperglycemia ratio on mortality in patients with critical acute myocardial infarction: insight from american MIMIC-IV and the chinese CIN-II study

Cardiovasc Diabetol. 2023 Oct 21;22(1):281. doi: 10.1186/s12933-023-02012-1.

Authors

Jin Liu^#^{1

2}, Yang Zhou^#^{1

2}, Haozhang Huang^#^{1

2}, Rui Liu^#³, Yu Kang^#^{1

2}, Tingting Zhu⁴, Jielan Wu^{1

2

5}, Yuwei Gao⁶, Yuqi Li^{1

2

7}, Chenyang Wang^{1

2}, Shiqun Chen⁸, Nianjin Xie^{1

2}, Xueyan Zheng⁹, Ruilin Meng⁹, Yong Liu^{10

11}, Ning Tan^{12

13}, Fei Gao¹⁴

Affiliations

¹ Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Southern Medical University, Guangzhou, China.
² Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
³ School of Mathematics, South China University of Technology, Guangzhou, China.
⁴ Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK.
⁵ The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
⁶ Jinan university, Zhuhai People's Hospital, Zhuhai, China.
⁷ Department of Cardiology, Zhongshan City People's Hospital, Zhongshan, China.
⁸ Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China.
⁹ Institute of Control and Prevention for Chronic Non-infective Disease, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China.
¹⁰ Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Southern Medical University, Guangzhou, China. liuyong@gdph.org.cn.
¹¹ Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China. liuyong@gdph.org.cn.
¹² Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Southern Medical University, Guangzhou, China. tanning100@126.com.
¹³ Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China. tanning100@126.com.
¹⁴ Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. fgaomd@163.com.

^# Contributed equally.

Abstract

Background: Among patients with acute coronary syndrome and percutaneous coronary intervention, stress hyperglycemia ratio (SHR) is primarily associated with short-term unfavorable outcomes. However, the relationship between SHR and long-term worsen prognosis in acute myocardial infarction (AMI) patients admitted in intensive care unit (ICU) are not fully investigated, especially in those with different ethnicity. This study aimed to clarify the association of SHR with all-cause mortality in critical AMI patients from American and Chinese cohorts.

Methods: Overall 4,337 AMI patients with their first ICU admission from the American Medical Information Mart for Intensive Care (MIMIC)-IV database (n = 2,166) and Chinese multicenter registry cohort Cardiorenal ImprovemeNt II (CIN-II, n = 2,171) were included in this study. The patients were divided into 4 groups based on quantiles of SHR in both two cohorts.

Results: The total mortality was 23.8% (maximum follow-up time: 12.1 years) in American MIMIC-IV and 29.1% (maximum follow-up time: 14.1 years) in Chinese CIN-II. In MIMIC-IV cohort, patients with SHR of quartile 4 had higher risk of 1-year (adjusted hazard radio [aHR] = 1.87; 95% CI: 1.40-2.50) and long-term (aHR = 1.63; 95% CI: 1.27-2.09) all-cause mortality than quartile 2 (as reference). Similar results were observed in CIN-II cohort (1-year mortality: aHR = 1.44; 95%CI: 1.03-2.02; long-term mortality: aHR = 1.32; 95%CI: 1.05-1.66). In both two group, restricted cubic splines indicated a J-shaped correlation between SHR and all-cause mortality. In subgroup analysis, SHR was significantly associated with higher 1-year and long-term all-cause mortality among patients without diabetes in both MIMIC-IV and CIN-II cohort.

Conclusion: Among critical AMI patients, elevated SHR is significantly associated with and 1-year and long-term all-cause mortality, especially in those without diabetes, and the results are consistently in both American and Chinese cohorts.

Keywords: Coronary artery disease; Diabetes; Mortality; Stress hyperglycemia ratio.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

China / epidemiology
East Asian People
Humans
Hyperglycemia*
Myocardial Infarction* / complications
Myocardial Infarction* / diagnosis
Myocardial Infarction* / mortality
Myocardial Infarction* / therapy
Prognosis
United States / epidemiology