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Aim <p>The stress hyperglycemia ratio (SHR) is a novel biomarker that reflects true acute hyperglycemia and has been associated with adverse outcomes and an increased risk of cardiovascular events in patients with myocardial infarction (MI). However, the relationship between SHR and different culprit plaque phenotypes in acute myocardial infarction (AMI) remains unexplored. This study aims to investigate the association between SHR and clinical outcomes in AMI patients stratified by plaque phenotype.</p> Methods <p>Between March 2017 and January 2020, a total of 1698 AMI patients were prospectively enrolled. Of these, 364 underwent optical coherence tomography (OCT) to assess culprit lesion morphology. SHR was calculated using the formula: [admission blood glucose (mmol/L)]/[1.59 × HbA1c (%)–2.59]. The primary endpoint was the occurrence of major adverse cardiovascular events (MACEs), defined as a composite of all-cause death, recurrent MI, ischemic stroke, and rehospitalization due to heart failure.</p> Results <p>Overall, patients were divided into two groups according to quartile of SHR (Q1–Q3 vs. Q4). After a median follow-up of 4&#xa0;years, elevated SHR was independently associated with an increased risk of MACEs after adjustment (HR: 1.14, 95% CI 1.05–1.24, <i>p</i> = 0.002). In patients with plaque rupture (PR), SHR remained a significant predictor of MACEs after adjustment (HR: 2.09, 95% CI 1.17–3.73, <i>p</i> = 0.013). In contrast, among patients with plaque erosion (PE), no significant difference in MACEs was observed across SHR-based groups (HR: 1.49, 95% CI 0.66–3.38, <i>p</i> = 0.342).</p> Conclusions <p>This study demonstrates that AMI patients with elevated SHR (&gt; 1.2) experience significantly worse clinical outcomes compared to those with lower SHR (≤ 1.2). The prognostic value of SHR was particularly evident in patients with PR rather than those with PE, suggesting its utility for risk stratification and guiding precision management in patients with PR.</p>

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Prognostic value of stress hyperglycemia ratio in patients with different plaque types with acute myocardial infarction

  • 期刊论文

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  • 发表日期：

    2025年12月1日

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  • Jiannan Li,
  • Linghan Xue,
  • Runzhen Chen,
  • Chen Liu,
  • Peng Zhou,
  • Yi Chen,
  • Li Song,
  • Nan Li,
  • Xiaoxiao Zhao,
  • Hongbing Yan,
  • Hanjun Zhao

摘要

Aim

The stress hyperglycemia ratio (SHR) is a novel biomarker that reflects true acute hyperglycemia and has been associated with adverse outcomes and an increased risk of cardiovascular events in patients with myocardial infarction (MI). However, the relationship between SHR and different culprit plaque phenotypes in acute myocardial infarction (AMI) remains unexplored. This study aims to investigate the association between SHR and clinical outcomes in AMI patients stratified by plaque phenotype.

Methods

Between March 2017 and January 2020, a total of 1698 AMI patients were prospectively enrolled. Of these, 364 underwent optical coherence tomography (OCT) to assess culprit lesion morphology. SHR was calculated using the formula: [admission blood glucose (mmol/L)]/[1.59 × HbA1c (%)–2.59]. The primary endpoint was the occurrence of major adverse cardiovascular events (MACEs), defined as a composite of all-cause death, recurrent MI, ischemic stroke, and rehospitalization due to heart failure.

Results

Overall, patients were divided into two groups according to quartile of SHR (Q1–Q3 vs. Q4). After a median follow-up of 4 years, elevated SHR was independently associated with an increased risk of MACEs after adjustment (HR: 1.14, 95% CI 1.05–1.24, p = 0.002). In patients with plaque rupture (PR), SHR remained a significant predictor of MACEs after adjustment (HR: 2.09, 95% CI 1.17–3.73, p = 0.013). In contrast, among patients with plaque erosion (PE), no significant difference in MACEs was observed across SHR-based groups (HR: 1.49, 95% CI 0.66–3.38, p = 0.342).

Conclusions

This study demonstrates that AMI patients with elevated SHR (> 1.2) experience significantly worse clinical outcomes compared to those with lower SHR (≤ 1.2). The prognostic value of SHR was particularly evident in patients with PR rather than those with PE, suggesting its utility for risk stratification and guiding precision management in patients with PR.