Key result
Stress hyperglycemia ratio >0.9 in AMI linked to ~474% greater 90-day mortality risk per unit increase.
Why the study?
The relationship between Stress Hyperglycemia Ratio and short-term mortality risk in patients with a first diagnosis of acute myocardial infarction remains contentious.
Does an elevated Stress Hyperglycemia Ratio increase 90-day and 180-day mortality in patients with a first diagnosis of acute myocardial infarction?
Cohort (n=1,961)
No
Does an elevated Stress Hyperglycemia Ratio increase 90-day and 180-day mortality in patients with a first diagnosis of acute myocardial infarction?
Hazard Ratio: 5.74 (95% CI 3.19–10.33)
In patients with a first diagnosis of acute myocardial infarction, a Stress Hyperglycemia Ratio above 0.9 is strongly associated with increased short-term mortality, highlighting its potential as a prognostic marker.
May support SHR as prognostic marker in first AMI; leaves open prospective validation and incremental value.
Aims:The Stress Hyperglycemia Ratio (SHR) potently predicts adverse outcomes in patients with cardiovascular and cerebrovascular diseases. However, the relationship between SHR and short-term mortality risk in patients with a first diagnosis of acute myocardial infarction (AMI) remains contentious. This study sought to understand better the relationship between SHR and short-term mortality risk in patients with a first diagnosis of AMI. Methods:We conducted a cohort study using data from 1961 patients with a first diagnosis of AMI from the MIMIC-IV (version 2.2) database. Patients were divided into three groups based on SHR tertiles. The Cox proportional hazards model and a two-segmented Cox proportional hazards model were used to elucidate the nonlinear relationship between SHR in patients with a first diagnosis of AMI and mortality were used to elucidate the nonlinear relationship between SHR in patients with a first diagnosis of AMI and mortality. Results:Of the surveyed population, 175 patients (8.92%) died within 90 days, and 210 patients (10.71%) died within 180 days. After multivariate adjustments, elevated SHR levels were significantly and non-linearly associated with a higher risk of 90-day and 180-day mortality in patients with a first diagnosis of AMI, showing a J-shaped correlation with an inflection point at 0.9. Compared to participants with SHR levels below the inflection point, those with higher SHR levels had a 474% increased risk of 90-day mortality (hazard ratio [HR] 5.74; 95% confidence interval [CI] 3.19,10.33) and a 356% increased risk of 180-day mortality (HR 4.56; 95% CI 2.62, 7.95). In the subgroup analysis, patients with pre-diabetes mellitus (pre-DM) and higher SHR levels had increased 90-day (HR 6.90; 95% CI 1.98, 24.02) and 180-day mortality risks (HR 5.30; 95% CI 1.96, 14.27). Conclusion:In patients with a first diagnosis of AMI, there is a J-shaped correlation between SHR and 90-day and 180-day mortality, with an adverse prognostic inflection point of SHR at 0.9.
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Hu et al. (2023) conducted a cohort in Acute Myocardial Infarction (n=1,961). Stress Hyperglycemia Ratio (SHR) vs. SHR levels below 0.9 was evaluated on 90-day mortality (HR 5.74, 95% CI 3.19-10.33). In patients with a first diagnosis of acute myocardial infarction, stress hyperglycemia ratio levels above 0.9 were associated with a 474% increased risk of 90-day mortality per unit increase (HR 5.74).
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