Key result
High stress hyperglycemia ratio (≥1.119) combined with new-onset atrial fibrillation was associated with an increased risk of MACE compared to neither condition (HR 2.18; 95% CI 1.39-3.42).
Why the study?
To investigate the predictive value and prognostic impact of the stress hyperglycemia ratio for new-onset atrial fibrillation complicating acute myocardial infarction.
Does stress hyperglycemia ratio predict new-onset atrial fibrillation and major adverse cardiovascular events in patients with acute myocardial infarction?
Cohort (n=2,145)
Does stress hyperglycemia ratio predict new-onset atrial fibrillation and major adverse cardiovascular events in patients with acute myocardial infarction?
Hazard Ratio: 2.18 (95% CI 1.39–3.42)
Stress hyperglycemia ratio is an independent predictor of new-onset atrial fibrillation and long-term adverse cardiovascular events in patients presenting with acute myocardial infarction.
May identify high-risk AMI patients for closer monitoring; leaves open whether SHR modification improves outcomes in prospective trials.
AIMS: To investigate the predictive value and prognostic impact of stress hyperglycemia ratio (SHR) for new-onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI). MATERIALS AND METHODS: This retrospective study included 2145 AMI patients without AF history between February 2014 and March 2018. SHR was calculated using fasting blood glucose (mmol/L)/[1.59*HbA1c (%)-2.59]. The association between SHR and post-MI NOAF was assessed with multivariable logistic regression analyses. The primary outcome was a composite of cardiac death, heart failure hospitalisation, recurrent MI, and ischaemic stroke (MACE). Cox regression-adjusted hazard ratios with 95% confidence intervals (CI) were estimated for MACE. RESULTS: A total of 245 (11.4%) patients developed NOAF. In the multivariable logistic regression analyses, SHR (each 10% increase) was significantly associated with increased risks of NOAF in the whole population (OR: 1.05, 95% CI: 1.01-1.10), particularly in non-diabetic individuals (OR:1.08, 95% CI: 1.01-1.17). During a median follow-up of 2.7 years, 370 (18.5%) MACEs were recorded. The optimal cut-off value of SHR for MACE prediction was 1.119. Patients with both high SHR (≥1.119) and NOAF possessed the highest risk of MACE compared to those with neither high SHR nor NOAF after multivariable adjustment (HR: 2.18, 95% CI: 1.39-3.42), especially for diabetics (HR: 2.63, 95% CI: 1.41-4.91). Similar findings were observed using competing-risk models. CONCLUSIONS: SHR is an independent predictor of post-MI NOAF in non-diabetic individuals. Diabetic patients with both high SHR and NOAF had the highest risk of MACE, suggesting that therapies targeting SHR may be considered in these patients. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03533543.
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Luo et al. (2023) conducted a cohort in acute myocardial infarction (n=2,145). Stress hyperglycemia ratio (SHR) vs. Neither high SHR nor new-onset atrial fibrillation was evaluated on composite of cardiac death, heart failure hospitalisation, recurrent MI, and ischaemic stroke (MACE) (HR 2.18, 95% CI 1.39-3.42). High stress hyperglycemia ratio (≥1.119) combined with new-onset atrial fibrillation was associated with an increased risk of MACE compared to neither condition (HR 2.18; 95% CI 1.39-3.42).
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