What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction (n=2311). Intervention: Stress hyperglycemia ratio (SHR) vs. Admission glucose. Primary outcome: Prediction of 28-day mortality (AUC) in non-diabetic patients (95% CI 0.6317-0.7496, p=0.0351).

May 9, 2022Open Access

Prognostic value of stress hyperglycemia ratio on short- and long-term mortality after acute myocardial infarction

TSTimo SchmitzUniversity of Augsburg DFDennis FreuerUniversity of Augsburg EHEva HarmelUniversity Hospital Augsburg

Key Result

In non-diabetic patients with acute myocardial infarction, stress hyperglycemia ratio was a significantly weaker predictor of 28-day mortality compared to admission glucose (AUC 0.6912 vs 0.716, p=0.0351).

Study Design

Type

Cohort (n=2,311)

Multicenter

Structured PICO

Does stress hyperglycemia ratio (SHR) provide better prognostic value for short- and long-term mortality compared to admission blood glucose in patients with acute myocardial infarction?

Population

2,311 patients aged 25-84 years with acute myocardial infarction were followed for a median of 6.5 years to compare the prognostic value of stress hyperglycemia ratio versus admission glucose.

Exposure

Stress hyperglycemia ratio (SHR) calculated as admission glucose (mg/dl)/(28.7 × HbA1c (%)-46.7)

Comparator

Admission blood glucose

Outcome

28-day mortality and 5-year all-cause mortalityhard clinical

Stress hyperglycemia ratio does not outperform simple admission blood glucose for predicting short- or long-term mortality in patients with acute myocardial infarction.

Main Result

Absolute Event Rate: 0.6912% vs 0.716%

p-value: p=0.0351

Limitations

The no diabetes group included patients with HbA1c values ≥5.7%, which might have influenced results
Observational design precludes proving causality
Potential residual confounding due to unavailable variables
Results cannot be applied to patients older than 84 years
Findings may not be generalizable to all ethnic groups

Abstract

AIMS: Prior studies demonstrated an association between hospital admission blood glucose and mortality in acute myocardial infarction (AMI). Because stress hyperglycemia ratio (SHR) has been suggested as a more reliable marker of stress hyperglycemia this study investigated to what extent SHR in comparison with admission blood glucose is associated with short- and long-term mortality in diabetic and non-diabetic AMI patients. METHODS: The analysis was based on 2,311 AMI patients aged 25-84 years from the population-based Myocardial Infarction Registry Augsburg (median follow-up time 6.5 years IQR: 4.9-8.1). The SHR was calculated as admission glucose (mg/dl)/(28.7 × HbA1c (%)-46.7). Using logistic and COX regression analyses the associations between SHR and admission glucose and mortality were investigated. RESULT: Higher admission glucose and higher SHR were significantly and nonlinearly associated with higher 28-day mortality in AMI patients with and without diabetes. In patients without diabetes, the AUC for SHR was significantly lower than for admission glucose (SHR: 0.6912 95%CI 0.6317-0.7496, admission glucose: 0.716 95%CI 0.6572-0.7736, p-value: 0.0351). In patients with diabetes the AUCs were similar for SHR and admission glucose. Increasing admission glucose and SHR were significantly nonlinearly associated with higher 5-year all-cause mortality in AMI patients with diabetes but not in non-diabetic patients. AUC values indicated a comparable prediction of 5-year mortality for both measures in diabetic and non-diabetic patients. CONCLUSIONS: Stress hyperglycemia in AMI patients plays a significant role mainly with regard to short-term prognosis, but barely so for long-term prognosis, underlining the assumption that it is a transient dynamic disorder that occurs to varying degrees during the acute event, thereby affecting prognosis.

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