Xiong Shiqiang, Luo Yan, Chen Qiang, Chen Yingzhong, Su Hong, Long Yu, Chen Xu, Yang Siqi, Qi Lingyao, Huang Wenchao, Hou Jun, Liu Hanxiong, Cai Lin
From Affiliated Hospital of Southwest Jiaotong University, the Third People's Hospital of Chengdu, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, China.
From Affiliated Hospital of Southwest Jiaotong University, the Third People's Hospital of Chengdu, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, China.
Diabetes Res Clin Pract. 2023 Apr;198:110601. doi: 10.1016/j.diabres.2023.110601. Epub 2023 Mar 5.
The predictive value of the stress hyperglycemia ratio (SHR) for long-term prognosis in acute coronary syndrome (ACS) is inconsistent. Whether the SHR provides additional prognostic value in addition to the GRACE score in ACS patients undergoing percutaneous coronary intervention (PCI) remains unknown.
A development-validation method was adopted to develop an algorithm to adjust the GRACE score using the SHR in ACS patients undergoing PCI from 11 hospitals.
During a median follow-up of 31.33 months, the occurrence of major adverse cardiac events (MACEs), defined as a composite of all-cause mortality and nonfatal myocardial infarction, was more frequent in the patients with a higher level of SHR. The SHR independently predicted long-term MACEs (hazard ratio 3.3479; 95% CI 1.4103-7.9475; P = 0.0062). Adjustment of the GRACE risk by addition of the SHR increased the C-statistic from 0.706 (95% CI: 0.599-0.813) to 0.727 (95% CI: 0.616-0.837) (P < 0.01), with a continuous net reclassification improvement of 30.5% and an integrated discrimination improvement of 0.042 (P < 0.01) in the derivation cohort; and addition of the SHR showed superior discrimination and good calibration in the validation cohort.
The SHR is an independent predictor of long-term MACEs in ACS patients undergoing PCI and markedly improves the performance of the GRACE score.
应激性高血糖比值（SHR）对急性冠脉综合征（ACS）长期预后的预测价值并不一致。在接受经皮冠状动脉介入治疗（PCI）的ACS患者中，SHR除GRACE评分外是否还具有额外的预后价值仍不清楚。
采用开发-验证方法，开发一种算法，以利用来自11家医院的接受PCI的ACS患者的SHR来调整GRACE评分。
在中位随访31.33个月期间，主要不良心脏事件（MACE，定义为全因死亡率和非致命性心肌梗死的综合）在SHR水平较高的患者中更频繁发生。SHR独立预测长期MACE（风险比3.3479；95%置信区间1.4103 - 7.9475；P = 0.0062）。通过加入SHR调整GRACE风险，在推导队列中，C统计量从0.706（95%置信区间：0.599 - 0.813）增加到0.727（95%置信区间：0.616 - 0.837）（P < 0.01），连续净重新分类改善为30.5%，综合辨别改善为0.042（P < 0.01）；在验证队列中，加入SHR显示出更好的辨别能力和良好的校准。
SHR是接受PCI的ACS患者长期MACE的独立预测因子，并显著提高了GRACE评分的性能。
