Relationship between stress hyperglycemic ratio and incidence of in-hospital cardiac arrest in patients with acute coronary syndrome: a retrospective cohort study

Background Stress hyperglycemic ratio (SHR), a new marker that reflects the true hyperglycemic state of acute coronary syndrome (ACS) patients, is strongly associated with adverse clinical outcomes in these patients. Studies on the relationship between SHR and in-hospital cardiac arrest (IHCA) incidence are limited. This study aimed to elucidate the relationship between SHR and the incidence of IHCA in patients with ACS. Methods In total, 1,939 ACS patients who underwent percutaneous coronary intervention (PCI) at the Affiliated Hospital of Zunyi Medical University were included. They were divided into three groups according to the degree of SHR: group T1 (SHR ≤ 0.84, N = 646), group T2 (0.84 < SHR ≤ 1.14, N = 646) and group T3 (SHR3 > 1.14, N = 647). The primary endpoint was IHCA incidence. Results The overall IHCA incidence was 4.1% (N = 80). The results of restricted cubic spline (RCS) analysis showed that after adjusting for covariates, SHR was significantly associated with the incidence of IHCA in patients with ACS (odds ratio [OR] = 6.46; 95% confidence interval [CI] = 1.20–34.73; P = 0.030) and an increased risk of IHCA was observed in the T3 group compared with the T1 group (OR = 1.13; 95% CI = 0.43–2.97; P = 0.797). In the subgroup analysis of diabetes mellitus (DM) patients, those without DM history showed an elevated IHCA risk in the T3 group (OR = 3.34; 95% CI = 0.40–27.85; P = 0.265). After adjusting for covariates, patients with DM history also demonstrated a slightly increased IHCA risk (OR = 1.16; 95% CI = 0.17–7.70; P = 0.880). The subgroup analysis of patients with ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina pectoris (UA) revealed that, after adjusting for covariates, the risk of IHCA was increased in patients with UA in the T3 group (OR = 3.00; 95% CI = 0.23–39.13; P = 0.402). A dose-response relationship was observed between the incidence of IHCA and SHR, with higher SHR values (> 0.97) associated with an elevated risk of IHCA occurrence. Moreover, the area under the curve for SHR in predicting IHCA incidence in ACS patients was 0.64. Conclusion In ACS patients treated with PCI, SHR was significantly associated with the incidence of IHCA in ACS patients. SHR may be a useful predictor of the incidence of IHCA in ACS patients.