Zhang Chong, Liu Junxiang, Liu Wennan, Liu Hangkuan, Sun Pengfei, Fang Yiwen, Yang Jingbo, Sun Haonan, Li Yongle, Foo Roger Sik-Yin, Sia Ching-Hui, Fonarow Gregg C, Yang Qing, Liu Yingwu, Zhou Xin
Department of Cardiology, Tianjin Medical University General Hospital.
Department of Heart Center, The Third Central Hospital of Tianjin.
Circ J. 2025 Jul 25;89(8):1228-1237. doi: 10.1253/circj.CJ-25-0017. Epub 2025 Jun 6.
Relative hyperglycemia, as defined by the stress hyperglycemia ratio (SHR), is linked to death and ischemic events in patients with acute coronary syndrome (ACS). As a modifiable factor, the association between SHR and bleeding risk after percutaneous coronary intervention (PCI) across different glycemic status remains unexplored.
In this study, ACS patients treated with PCI were extracted from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) registry and the Tianjin Health and Medical Data Platform (THMDP). SHR was derived from admission fasting blood glucose and hemoglobin A1c. Patients were classified as having diabetes mellitus, pre-diabetes mellitus (Pre-DM), or normal glucose regulation. The primary outcome was in-hospital major bleeding. Among the 33,265 patients in the CCC-ACS cohort, major bleeding was recorded for 437. A high SHR (>1.0) independently predicted major bleeding in the total cohort (adjusted odds ratio [aOR] 1.51; 95% confidence interval [CI] 1.24-1.83), with the highest risk in the Pre-DM group (aOR 1.98; 95% CI 1.34-2.92). These findings were externally validated among 23,423 patients with myocardial infarction in the THMDP cohort. Early guideline-directed medical therapy mitigated the bleeding risk associated with a high SHR.
In this study, a high SHR was an independent risk factor for in-hospital major bleeding after PCI, particularly in patients with Pre-DM. Further clinical trials are needed to explore SHR-targeted therapies in Pre-DM.
应激性高血糖比（SHR）所定义的相对高血糖与急性冠状动脉综合征（ACS）患者的死亡和缺血事件相关。作为一个可改变的因素，不同血糖状态下SHR与经皮冠状动脉介入治疗（PCI）后出血风险之间的关联尚未得到探索。
在本研究中，接受PCI治疗的ACS患者来自中国心血管疾病改善-急性冠状动脉综合征（CCC-ACS）注册研究和天津健康与医学数据平台（THMDP）。SHR由入院时的空腹血糖和糖化血红蛋白得出。患者被分类为患有糖尿病、糖尿病前期（Pre-DM）或血糖调节正常。主要结局是住院期间的大出血。在CCC-ACS队列的33265例患者中，记录到437例大出血。高SHR（>1.0）独立预测了整个队列中的大出血（调整后的优势比[aOR]为1.51；95%置信区间[CI]为1.24-1.83），在Pre-DM组中风险最高（aOR为1.98；95%CI为1.34-2.92）。这些发现在THMDP队列的23423例心肌梗死患者中得到了外部验证。早期的指南导向药物治疗减轻了与高SHR相关的出血风险。
在本研究中，高SHR是PCI后住院期间大出血的独立危险因素，尤其是在Pre-DM患者中。需要进一步的临床试验来探索针对Pre-DM的以SHR为靶点的治疗方法。
