Ma Xiaoteng, Chu Huijun, Sun Yan, Cheng Yujing, Zhang Dai, Yang Lixia, Wang Zhijian, Liu Xiaoli, Zhou Yujie
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
Department of Anesthesia, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Thromb J. 2025 May 12;23(1):47. doi: 10.1186/s12959-025-00729-5.
Prognostic significance of stress hyperglycemia ratio (SHR) has not been well studied in patients with type 2 diabetes mellitus (T2DM) and acute coronary syndromes (ACS).
We prospectively measured admission fasting blood glucose (AFBG) and glycated hemoglobin A1c (HbA1c), and retrospectively calculated the stress hyperglycemia ratio (SHR, = AFBG/[1.59 × HbA1c (%) - 2.59]) in 791 patients with T2DM and ACS undergoing percutaneous coronary intervention (PCI). The primary endpoint was defined as major adverse cardiovascular and cerebrovascular events (MACCE), including all-cause mortality, non-fatal stroke, non-fatal myocardial infarction, and unplanned repeat coronary revascularization.
The mean age of the study population was 61 ± 10 years, and 72.8% were male. Over a median follow-up of 927 days, 194 patients developed at least one primary endpoint event. The follow-up incidence of MACCE increased in parallel with SHR tertiles (15.6%, 21.9%, and 36.1%, respectively; P for trend < 0.001). The Cox proportional hazards regression analysis adjusted for multiple confounding factors showed hazard ratios for MACCE of 1.525 (95% CI: 1.009-2.305; P = 0.045) for the middle tertile and 2.525 (95% CI: 1.729-3.687; P < 0.001) for the highest tertile of SHR, with the lowest tertile as the reference. The addition of SHR to the baseline reference prediction model improved model predictive performance markedly (C-statistic: increased from 0.704 to 0.721; cNRI: 0.176 [95% CI: 0.063-0.282], P = 0.002; IDI: 0.030 [95% CI: 0.009-0.063], P = 0.002).
SHR was independently and significantly associated with adverse cardiovascular outcomes in T2DM and ACS patients who underwent PCI, and had an incremental effect on the predictive ability of the baseline reference prediction model.
应激性高血糖比值（SHR）在2型糖尿病（T2DM）合并急性冠状动脉综合征（ACS）患者中的预后意义尚未得到充分研究。
我们前瞻性地测量了791例接受经皮冠状动脉介入治疗（PCI）的T2DM合并ACS患者的入院空腹血糖（AFBG）和糖化血红蛋白A1c（HbA1c），并回顾性计算了应激性高血糖比值（SHR，=AFBG/[1.59×HbA1c（%）-2.59]）。主要终点定义为主要不良心血管和脑血管事件（MACCE），包括全因死亡率、非致命性卒中、非致命性心肌梗死和计划外再次冠状动脉血运重建。
研究人群的平均年龄为61±10岁，男性占72.8%。在中位随访927天期间，194例患者发生了至少1次主要终点事件。MACCE的随访发生率随SHR三分位数平行增加（分别为15.6%、21.9%和36.1%；趋势P<0.001）。经多个混杂因素校正的Cox比例风险回归分析显示，SHR中间三分位数的MACCE风险比为1.525（95%CI：1.009-2.305；P=0.045），最高三分位数为2.525（95%CI：1.729-3.687；P<0.001），以最低三分位数为参照。将SHR添加到基线参考预测模型中显著提高了模型的预测性能（C统计量：从0.704增加到0.721；cNRI：0.176[95%CI：0.063-0.282]，P=0.002；IDI：0.030[95%CI：0.009-0.063]，P=0.002）。
SHR与接受PCI的T2DM合并ACS患者的不良心血管结局独立且显著相关，并且对基线参考预测模型的预测能力有增量作用。
