Okita Shogo, Saito Yuichi, Yaginuma Hiroaki, Asada Kazunari, Goto Hiroki, Hashimoto Osamu, Sato Takanori, Kitahara Hideki, Kobayashi Yoshio
Department of Cardiovascular Medicine, Chiba University Hospital.
Department of Cardiology, Chiba Emergency and Psychiatric Medical Center.
Circ J. 2025 Feb 25;89(3):340-346. doi: 10.1253/circj.CJ-24-0612. Epub 2024 Oct 22.
An acute hyperglycemic status is reportedly associated with poor prognosis in patients with acute cardiovascular diseases. Although the stress hyperglycemia ratio (SHR) is used to evaluate the hyperglycemic condition on admission, relationships between SHR and clinical outcomes, particularly heart failure (HF), remain uncertain in acute myocardial infarction (AMI).
This retrospective multicenter study included 2,386 patients with AMI undergoing percutaneous coronary intervention. SHR was calculated using blood glucose and HbA1c levels. Co-primary endpoints included HF-related events (death, worsening HF, and hospitalization for HF) and major adverse cardiovascular events (MACE; death, recurrent AMI, and ischemic stroke) during the index hospitalization and after discharge. The mean (±SD) SHR was 1.30±0.51; HF events and MACE occurred in 680 (28.5%) and 233 (9.8%) patients during hospitalization, respectively. SHR was independently associated with in-hospital HF events and MACE. Of 2,017 patients who survived to discharge, 195 (9.7%) and 214 (10.6%) experienced HF events and MACE, respectively, over a median follow-up of 536 days. The risk of HF events was higher in patients with a high (>1.45) SHR than in those with SHR ≤1.45; there was no significant difference in MACE rates after discharge between these 2 groups.
In AMI patients, SHR was predictive of in-hospital outcomes, including HF events and MACE, whereas after discharge a higher SHR was associated with higher HF risks, but not MACE.
据报道，急性高血糖状态与急性心血管疾病患者的不良预后相关。尽管应激性高血糖比率（SHR）用于评估入院时的高血糖状况，但在急性心肌梗死（AMI）中，SHR与临床结局，尤其是心力衰竭（HF）之间的关系仍不明确。
这项回顾性多中心研究纳入了2386例行经皮冠状动脉介入治疗的AMI患者。使用血糖和糖化血红蛋白水平计算SHR。共同主要终点包括住院期间和出院后与HF相关的事件（死亡、HF恶化和因HF住院）以及主要不良心血管事件（MACE；死亡、复发性AMI和缺血性卒中）。SHR的平均值（±标准差）为1.30±0.51；住院期间分别有680例（28.5%）和233例（9.8%）患者发生HF事件和MACE。SHR与住院期间的HF事件和MACE独立相关。在2017例存活至出院的患者中，在中位随访536天期间，分别有195例（9.7%）和214例（10.6%）发生HF事件和MACE。SHR高（>1.4５）的患者发生HF事件的风险高于SHR≤1.45的患者；两组出院后MACE发生率无显著差异。
在AMI患者中，SHR可预测住院期间的结局，包括HF事件和MACE，而出院后较高的SHR与较高的HF风险相关，但与MACE无关。
