Association Between Stress Hyperglycemia Ratio and In-hospital Outcomes in Elderly Patients With Acute Myocardial Infarction.

Guo Chen,Yingling Zhou,Ling Xue,Rui Wang,Xiaodan Wen,Mingmin Li,Xuyu He

doi:10.3389/fcvm.2021.698725

Abstract

Backgrounds: Emerging evidence suggests that stress hyperglycemia ratio (SHR), an index of relative stress hyperglycemia, is of great prognostic value in acute myocardial infarction (AMI), but current evidence is limited in elderly patients. In this study, we aimed to assess whether SHR is associated with in-hospital outcomes in elderly patients with AMI.Methods: In this retrospective study, patients who were aged over 75 years and diagnosed with AMI were consecutively enrolled from 2015, January 1st to 2019, December 31th. Admission blood glucose and glycosylated hemoglobin (HbA1C) during the index hospitalization were used to calculate SHR. Restricted quadratic splines, receiver-operating curves, and logistic regression were performed to evaluate the association between SHR and in-hospital outcomes, including in-hospital all-cause death and in-hospital major adverse cardiac and cerebrovascular events (MACCEs) defined as a composite of all-cause death, cardiogenic shock, reinfarction, mechanical complications of MI, stroke, and major bleeding.Results: A total of 341 subjects were included in this study. Higher SHR levels were observed in patients who had MACCEs (n = 69) or death (n = 44) during hospitalization. Compared with a SHR value below 1.25, a high SHR was independently associated with in-hospital MACCEs (odds ratio [OR]: 2.945, 95% confidence interval [CI]: 1.626–5.334, P < 0.001) and all-cause death (OR: 2.871 95% CI: 1.428–5.772, P = 0.003) in univariate and multivariate logisitic analysis. This relationship increased with SHR levels based on a non-linear dose-response curve. In contrast, admission glucose was only associated with clinical outcomes in univariate analysis. In subgroup analysis, high SHR was significantly predictive of worse in-hospital clinical outcomes in non-diabetic patients (MACCEs: 2.716 [1.281–5.762], P = 0.009; all-cause death: 2.394 [1.040–5.507], P = 0.040), but the association was not significant in diabetic patients.Conclusion: SHR might serve as a simple and independent indicator of adverse in-hospital outcomes in elderly patients with AMI, especially in non-diabetic population.

Highlights

Despite the marked progress in primary percutaneous coronary intervention (PCI) and medical management in the past decade, acute myocardial infarction (AMI) remains one of the leading causes of death worldwide [1]
Numerous risk factors have been reported to be associated with adverse outcomes of AMI patients, among which chronic hyperglycemia has been welldocumented among all age groups
Cardiac arrest before admission, Killip class, heart rate, systolic blood pressure (SBP), S2B, PCI or not, complete revascularization, NT-proBNP, left ventricular ejection fraction (LVEF), admission glucose as well as a stress hyperglycemia ratio (SHR) ≥ 1.25 significantly predicted in-hospital major adverse cardiovascular and cerebrovascular events (MACCEs) (OR: 3.094, 95% CI: 1.794–5.337, P < 0.001, Table 3)

Summary

Introduction

Despite the marked progress in primary percutaneous coronary intervention (PCI) and medical management in the past decade, acute myocardial infarction (AMI) remains one of the leading causes of death worldwide [1]. Stress-induced hyperglycemia (SIH), an acute physiological response to stress, has been identified as a strong predictor of mortality in critically ill patients [2,3,4]. A higher mortality was observed in AMI patients with acute-onset of hyperglycemia than in those with chronic hyperglycemia, suggesting different mechanisms may mediate the extremely harmful effects of SIH [5, 6]. The outcome-predicting significance of SIH in AMI patients varies among previous studies [7,8,9]. Since the absolute admission glucose values could result from acute physiological stress, chronic high baseline glucose levels or both, it does not always accurately reflect the intensity of SIH [10]

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