Novel admission hyperglycaemia markers as predictors of poor outcomes following percutaneous coronary interventions: a dose-response meta-analysis

Background Admission hyperglycaemia markers are known as acute glycaemic parameters reflecting transient hyperglycemic conditions from physiological stress responses. Early and effective risk stratification of poor outcomes can significantly enhance patients’ clinical management following Percutaneous Coronary Intervention (PCI) procedures. The potential prognostic significance of novel admission hyperglycemia markers, such as stress hyperglycemia ratio (SHR) and glycaemic gap (GG), remains largely unexplored. Purpose To investigate the association of ABG, GG, and SHR with poor outcomes in post-PCI patients. Methods A comprehensive search was conducted on February 2nd 2025 across multiple electronic databases such as PubMed, Scopus, Web of Science, and Cochrane to search for eligible studies. SHR was defined as [(admission glucose (mmol/L) / [1.59 × HbA1c (%)−2.59], difference between plasma glucose at admission and A1C-derived average glucose levels. Poor outcomes were categorized into multiple endpoints, including mortality, MACE, target vessel revascularization, TIMI frame count, and length of hospitalization. Linear trend was estimated using generalized least squares method and pooled using two-stage random effect meta analysis and any potential for non-linear dose-response were assessed using three knots model restricted cubic splines and pooled using restricted maximum likelihood method in a multivariate random-effects meta-analysis. The Wald test was used to investigate non-linearity. Significance level was set at p < .05 in all analyses. The statistical analysis was conducted using R Studio version 4.4.2. Results This systematic review included 26 eligible studies, enrolling 78,581 participants. Each 1 mmol/L increase in ABG corresponded to a 17% increased risk of mortality (HR 1.17 [95% CI 1.05–1.30], p = 0.003), with significant non-linearity in the dose-response model (Pnon-linearity = 0.014). Compared to 4.691 mmol/L, only ABG levels of ≥7.691 mmol/L were significantly associated with an increased risk of mortality following PCI. Across the SHR range of 0.375 to 1.375, each 0.1-unit increase in SHR was linked to an 11% higher risk of mortality and MACE (HR 1.11 [95% CI 1.07–1.15], p = 0.000). Similarly, in the 0.655 to 1.455 range, each 0.1-unit increase in SHR increased the risk of mortality and MACE by 12% (HR 1.12 [95% CI 1.03–1.24]). However, only SHR values of ≥0.875 (compared to 0.375, Pnon-linearity < 0.001) exhibited a significant mortality risk, and SHR values of ≥1.155 (compared to 0.655, Pnon-linearity < 0.001) were significantly associated with increased MACE risk in AMI patients following PCI. Conclusion The utilization of SHR, GG, and ABG as prognostic indicators in ACS patients undergoing PCI holds promise for enhancing clinical decision-making, particularly among cardiologists.Dose Response SHR to Mortality after PCI