Stress Hyperglycemia Ratio and Its Correlation with Intracoronary Thrombus Burden in Diabetic Patients Suffering from ST-Segment Elevation Myocardial Infarction undergoing Primary Percutaneous Coronary Intervention

Background: Stress hyperglycemia ratio may reflect the acute glycemic response to myocardial infarction in diabetic patients. Its relation to intracoronary thrombus burden in ST-Segment Elevation Myocardial Infarction (STEMI) patients undergoing primary Percutaneous Coronary Intervention (PCI) is clinically relevant. This research aimed to evaluate the association between stress hyperglycemia ratio intracoronary thrombus burden in diabetic STEMI patients managed by primary PCI. Methods: This cross-sectional study included 84 diabetic patients presenting with STEMI undergoing primary PCI classified into a large thrombus burden group, grades 4–5, including 53 patients,small thrombus burden group, grades 0–3, including 31 patients. Stress hyperglycemia ratio was calculated as admission blood glucose divided by estimated average glucose derived from HbA1c. Intracoronary thrombus burden was assessed angiographically using TIMI thrombus grading. Results: SHR correlated positively with thrombus burden score (ρ = 0.457, p < 0.0001) and inversely with initial TIMI flow grade (ρ = −0.382, p = 0.0003). In univariable analysis, SHR predicted large thrombus burden (OR = 8.175, 95% CI: 1.486–44.963, p = 0.016). ROC analysis showed that SHR had the best discriminatory performance for large thrombus burden prediction (AUC = 0.781, p < 0.001), outperforming admission RBS and HbA1c. An SHR cut-off ≥1.314 showed 69.8% sensitivity and 80.6% specificity. Conclusion: SHR was significantly associated with intracoronary thrombus burden in diabetic STEMI patients undergoing primary PCI. It was higher in patients with large thrombus burden and outperformed admission glucose and HbA1c in predicting thrombotic risk, supporting its use as a simple admission marker for early risk stratification.