Key result
Elevated stress hyperglycemia ratio (SHR ≥ 0.80) significantly increased the risk of major adverse cardiac events by 2.3-fold (HR 2.325) in chronic coronary syndrome patients with coronary microvascular dysfunction.
Why the study?
Does an elevated stress hyperglycemia ratio predict major adverse cardiac events in patients with chronic coronary syndrome and coronary microvascular dysfunction?
Observational (n=379)
No
Does an elevated stress hyperglycemia ratio predict major adverse cardiac events in patients with chronic coronary syndrome and coronary microvascular dysfunction?
Effect estimate: HR 2.325 (95% CI 1.228-5.033)
Absolute Event Rate: 37.68% vs 16.67%
p-value: p=0.011
An elevated stress hyperglycemia ratio (SHR ≥ 0.80) is an independent predictor of coronary microvascular dysfunction and subsequent major adverse cardiac events in patients with chronic coronary syndrome.
Aims Coronary microvascular dysfunction (CMD) is a crucial prognostic indicator in chronic coronary syndrome (CCS) patients. The stress hyperglycemia ratio (SHR), a novel biomarker of acute hyperglycemia, has demonstrated predictive value for adverse outcomes in various diseases. However, its association with CMD remains unclear. This study aims to evaluate the prognostic role of SHR in predicting CMD outcomes in CCS patients. Methods CCS patients who underwent coronary angiography (CAG) were included. Microvascular function was assessed using coronary angiography-derived index of microcirculatory resistance (caIMR), with CMD defined as caIMR > 25U. Patients were divided into three groups based on SHR values: T1 (SHR < 0.73), T2 (SHR 0.73–0.80), and T3 (SHR≥0.80). The primary endpoint was major adverse cardiac events (MACE). Results 379 CCS patients were included, among which 196 were identified with CMD. The CMD group exhibited higher SHR levels. During a mean follow-up of 32.9 months, 53 MACE events occurred in CMD patients, with a higher incidence in the T3 group compared to the T1/T2 groups (37.681% vs. 16.667% vs. 26.230%, P = 0.023). SHR was identified as an independent predictor of CMD (OR 7.379, 95% CI: 1.305–41.725, P = 0.024). The T3 group demonstrated a 2.325-fold increased risk of MACE (HR 2.325, 95% CI: 1.228–5.033, P = 0.011), with a non-linear relationship observed between SHR and MACE (P for non-linear < 0.001). Conclusions Elevated SHR is associated with adverse outcomes and predicts MACE in CMD patients with CCS. These results highlight the potential of SHR as a valuable tool for early risk stratification and prevention in CMD management. Trial Registration ClinicalTrials.
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Alifu et al. (2026) conducted an observational in Chronic coronary syndrome with coronary microvascular dysfunction (n=379). Elevated stress hyperglycemia ratio (SHR ≥ 0.80) vs. Lower stress hyperglycemia ratio (SHR < 0.80) was evaluated on Major adverse cardiac events (MACE) (HR 2.325, 95% CI 1.228-5.033, p=0.011). Elevated stress hyperglycemia ratio (SHR ≥ 0.80) significantly increased the risk of major adverse cardiac events by 2.3-fold (HR 2.325) in chronic coronary syndrome patients with coronary microvascular dysfunction.
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