Yan Ning, Wu Peng, Zhang Zhengjun, Wang Mohan, Ma Juan, Ma Ali, Chen Dapeng, Ma Xueping, Li Xiaocheng
Heart Centre and Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, China.
First Clinical College, Ningxia Medical University, Yinchuan, China.
Front Endocrinol (Lausanne). 2025 Apr 15;16:1586541. doi: 10.3389/fendo.2025.1586541. eCollection 2025.
The Stress Hyperglycemia Ratio (SHR) is associated with poor outcomes in coronary artery disease patients, but its link to Acute Myocardial Infarction (AMI) prognosis is unclear. This study explores the relationship between SHR and 1-year outcomes after AMI using a large cohort analysis.
This retrospective study enrolled 4012 AMI patients from General Hospital of Ningxia Medical University(2016-2019). These patients were stratified into three distinct groups according to the tertiles of the SHR: Group T1 (SHR < 0.90, n=1337), Group T2 (0.90 ≤ SHR < 1.11, n=1337), and Group T3 (SHR ≥ 1.11, n=1338). All patients were clinically followed for 1-years to collect major adverse cardiovascular and cerebrovascular events (MACCE). After controlling for different confounding factors, cox regression models and restricted quadratic splines were used to investigate the relationship between SHR and 1-years clinical outcomes.
During the 1-year follow-up, 229 all-cause deaths were recorded, yielding a mortality rate of 5.71% (n=229). Additionally, 861 MACCE were recorded, yielding a MACCE rate of 21.46%. After adjusting for covariates, SHR was found to be significantly associated with 1-year MACCE [hazard ratio (HR) = 2.18; 95% confidence interval (CI) = 1.64-2.89; < 0.001] and all-cause mortality (HR = 3.11; 95% CI = 1.77-5.46; < 0.001) in patients with AMI, and the T3 group exhibited a higher risk of 1-year MACCE (HR = 1.67; 95% CI = 1.34-2.09; < 0.001) and all-cause mortality (HR = 1.67; 95% CI = 1.02-2.73; =0.042) compared with T1 group. A J-shaped relationship was observed between SHR and 1-year MACCE as well as all-cause mortality, showing a turning point at 0.87. Beyond this threshold, the hazard ratio for 1-year MACCE was 2.64 (95% CI: 1.91-3.65), and for all-cause mortality was 4.26 (95%: CI 2.30-7.86). The results remained consistent across subgroup.
SHR is significantly and positively associated with one-year clinical outcomes in patients with AMI. Furthermore, there is a specific non-linear association between SHR and MACCE and all-cause mortality (both inflection point 0.87). Interventions aimed at reducing SHR levels below 0.87 through medication management have the potential to significantly improve outcomes.
应激性高血糖比值（SHR）与冠状动脉疾病患者的不良预后相关，但其与急性心肌梗死（AMI）预后的联系尚不清楚。本研究采用大型队列分析探讨SHR与AMI后1年预后之间的关系。
这项回顾性研究纳入了宁夏医科大学总医院4012例AMI患者（2016 - 2019年）。根据SHR的三分位数将这些患者分为三个不同的组：T1组（SHR < 0.90，n = 1337），T2组（0.90≤SHR < 1.11，n = 1337），T3组（SHR≥1.11，n = 1338）。对所有患者进行为期1年的临床随访，以收集主要不良心血管和脑血管事件（MACCE）。在控制了不同的混杂因素后，使用cox回归模型和受限二次样条来研究SHR与1年临床结局之间的关系。
在1年的随访期间，记录了229例全因死亡，死亡率为5.71%（n = 229）。此外，记录了861例MACCE，MACCE发生率为21.46%。在调整协变量后，发现SHR与AMI患者的1年MACCE[风险比（HR）= 2.18；95%置信区间（CI）= 1.64 - 2.89；P < 0.001]和全因死亡率（HR = 3.11；95% CI = 1.77 - 5.46；P < 0.001）显著相关，与T1组相比，T3组1年MACCE（HR = 1.67；95% CI = 1.34 - 2.09；P < 0.001）和全因死亡率（HR = 1.67；95% CI = 1.02 - 2.73；P = 0.042）的风险更高。观察到SHR与1年MACCE以及全因死亡率之间呈J形关系，转折点为0.87。超过该阈值，1年MACCE的风险比为（HR）2.64（95% CI：1.91 - 3.65），全因死亡率的风险比为4.26（95% CI：2.30 - 7.86）。亚组分析结果一致。
SHR与AMI患者1年临床结局显著正相关。此外，SHR与MACCE和全因死亡率之间存在特定的非线性关联（拐点均为0.87）。通过药物管理将SHR水平降低至0.87以下的干预措施有可能显著改善预后。
