Department of Cardiovascular Medicine, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Zunyi, 563099, Guizhou, China.
Cardiovasc Diabetol. 2024 Feb 9;23(1):59. doi: 10.1186/s12933-024-02128-y.
The stress hyperglycaemic ratio (SHR), a new marker that reflects the true hyperglycaemic state of patients with acute coronary syndrome (ACS), is strongly associated with adverse clinical outcomes in these patients. Studies on the relationship between the SHR and in-hospital cardiac arrest (IHCA) incidence are limited. This study elucidated the relationship between the SHR and incidence of IHCA in patients with ACS.
In total, 1,939 patients with ACS 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 SHR: group T1 (SHR ≤ 0.838, N = 646), group T2 (0.838< SHR ≤ 1.140, N = 646), and group T3 (SHR3 > 1.140, N = 647). The primary endpoint was IHCA incidence.
The overall IHCA incidence was 4.1% (N = 80). After adjusting for covariates, SHR was significantly associated with IHCA incidence in patients with ACS who underwent PCI (odds ratio [OR] = 2.6800; 95% confidence interval [CI] = 1.6200-4.4300; p<0.001), and compared with the T1 group, the T3 group had an increased IHCA risk (OR = 2.1800; 95% CI = 1.2100-3.9300; p = 0.0090). In subgroup analyses, after adjusting for covariates, patients with ST-segment elevation myocardial infarction (STEMI) (OR = 3.0700; 95% CI = 1.4100-6.6600; p = 0.0050) and non-STEMI (NSTEMI) (OR = 2.9900; 95% CI = 1.1000-8.1100; p = 0.0310) were at an increased IHCA risk. After adjusting for covariates, IHCA risk was higher in patients with diabetes mellitus (DM) (OR = 2.5900; 95% CI = 1.4200-4.7300; p = 0.0020) and those without DM (non-DM) (OR = 3.3000; 95% CI = 1.2700-8.5800; p = 0.0140); patients with DM in the T3 group had an increased IHCA risk compared with those in the T1 group (OR = 2.4200; 95% CI = 1.0800-5.4300; p = 0.0320). The restriction cubic spline (RCS) analyses revealed a dose-response relationship between IHCA incidence and SHR, with an increased IHCA risk when SHR was higher than 1.773. Adding SHR to the baseline risk model improved the predictive value of IHCA in patients with ACS treated with PCI (net reclassification improvement [NRI]: 0.0734 [0.0058-0.1409], p = 0.0332; integrated discrimination improvement [IDI]: 0.0218 [0.0063-0.0374], p = 0.0060).
In patients with ACS treated with PCI, the SHR was significantly associated with the incidence of IHCA. The SHR may be a useful predictor of the incidence of IHCA in patients with ACS. The addition of the SHR to the baseline risk model had an incremental effect on the predictive value of IHCA in patients with ACS treated with PCI.
应激性高血糖比值（SHR）是一种新的标志物，可反映急性冠状动脉综合征（ACS）患者的真实高血糖状态，与这些患者的不良临床结局密切相关。关于 SHR 与院内心搏骤停（IHCA）发生率之间关系的研究有限。本研究旨在阐明 SHR 与 ACS 患者 IHCA 发生率之间的关系。
共纳入遵义医科大学附属医院行经皮冠状动脉介入治疗（PCI）的 1939 例 ACS 患者。根据 SHR 将其分为三组：T1 组（SHR≤0.838，N=646）、T2 组（0.838<SHR≤1.140，N=646）和 T3 组（SHR>1.140，N=647）。主要终点为 IHCA 发生率。
总体 IHCA 发生率为 4.1%（N=80）。调整混杂因素后，SHR 与 ACS 患者 PCI 后 IHCA 发生率显著相关（比值比[OR] =2.6800；95%置信区间[CI] =1.6200-4.4300；p<0.001），与 T1 组相比，T3 组 IHCA 风险增加（OR=2.1800；95%CI =1.2100-3.9300；p=0.0090）。亚组分析显示，调整混杂因素后，ST 段抬高型心肌梗死（STEMI）（OR=3.0700；95%CI =1.4100-6.6600；p=0.0050）和非 ST 段抬高型心肌梗死（NSTEMI）（OR=2.9900；95%CI =1.1000-8.1100；p=0.0310）患者 IHCA 风险增加。调整混杂因素后，糖尿病（DM）患者（OR=2.5900；95%CI =1.4200-4.7300；p=0.0020）和非 DM（non-DM）患者（OR=3.3000；95%CI =1.2700-8.5800；p=0.0140）的 IHCA 风险增加；与 T1 组相比，T3 组中 DM 患者 IHCA 风险增加（OR=2.4200；95%CI =1.0800-5.4300；p=0.0320）。限制立方样条（RCS）分析显示 IHCA 发生率与 SHR 之间存在剂量-反应关系，当 SHR 高于 1.773 时 IHCA 风险增加。将 SHR 添加到基线风险模型中可提高 ACS 患者 PCI 治疗后 IHCA 的预测价值（净重新分类改善[NRI]：0.0734[0.0058-0.1409]，p=0.0332；综合鉴别改善[IDI]：0.0218[0.0063-0.0374]，p=0.0060）。
在接受 PCI 治疗的 ACS 患者中，SHR 与 IHCA 发生率显著相关。SHR 可能是 ACS 患者 IHCA 发生率的有用预测指标。将 SHR 添加到基线风险模型对 ACS 患者 PCI 治疗后 IHCA 的预测价值具有增量作用。
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