Stress Hyperglycemia Ratio Predicts 28-Day Mortality in Patients with AMI Cardiogenic Shock: Insights from a Large-Scale Cohort

Background: The prognostic impact of the stress hyperglycemia ratio (SHR24) and blood glucose (BG) fluctuation within 24 h (ΔBG24) on cardiogenic shock complicating acute myocardial infarction (AMICS) remains unclear. This study evaluated the prognostic value of the SHR24 and ΔBG24 for short-term mortality in AMICS. Methods: We retrospectively analyzed AMICS patients from 2016 to 2022. The primary outcome was 28-day all-cause mortality. Associations were evaluated using Kaplan–Meier (K-M) curves, Cox proportional hazard regression, and restricted cubic spline (RCS) analyses. Results: A total of 179 participants with AMICS were enrolled. The mean age was 64.44 ± 12.61 years. K-M curves showed significant differences in survival across ΔBG24 and the SHR24 (p < 0.001). Cox regression identified culprit vessel final blood flow (HR = 0.58, 95% CI: 0.43–0.80), the SHR24 (HR = 2.99, 95% CI: 1.61–5.57), and CardShock score (HR = 1.52, 95% CI: 1.18–1.96) as independent predictors of mortality. RCS analysis confirmed a linear correlation between the SHR24 and all-cause mortality (p = 0.001). Adding the SHR24 and ΔBG24 to the IABP-SHOCK II score increased the AUC by 0.093 (13.29%, p = 0.013) and 0.080 (11.43%, p = 0.016), respectively. For the CardShock score, they increased the AUC by 0.091 (12.07%, p = 0.002) and 0.056 (7.43%, p = 0.03). Decision curve analysis further confirmed that both the SHR24 and ΔBG24 improved clinical decision-making benefit. Conclusions: The SHR24 and ΔBG24 are reliable predictors of short-term prognosis in patients with AMICS.