Stress hyperglycemia ratio and long-term prognosis in patients with acute myocardial infarction undergoing percutaneous coronary intervention: evidence for an J-shaped association.

BACKGROUND: Acute myocardial infarction (AMI) is a major cause of mortality worldwide. The stress hyperglycemia ratio (SHR), which integrates glucose and glycated hemoglobin A1c levels, better reflects acute metabolic stress. This study assessed the SHR and long-term prognosis of patients with AMI. METHODS: This study was a post-hoc analysis based on the prospective, multicenter OPTIMAL registry (http://www.clinicaltrials.gov, NCT number: NCT03084991). A total of 3384 consecutive patients who underwent percutaneous coronary intervention (PCI) at Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China were included in the present analysis after exclusions. Patients were stratified into quartiles according to the SHR. The primary endpoint was cardiovascular death, with all-cause death and major adverse cardiovascular events as secondary endpoints. The median follow-up duration was 24.1 months, with a completion rate of 99.5%. RESULTS: Kaplan-Meier survival curves showed progressively worse survival across SHR quartiles (log-rank P < 0.001), with patients in Q4 (SHR ≥ 1.34) experiencing the highest risk. Multivariate Cox regression analysis confirmed that the SHR was an independent predictor of cardiovascular death [hazard ratio (HR) = 1.56], all-cause death (HR = 1.48), and major adverse cardiovascular events (HR = 1.34) for Q4 (SHR ≥ 1.34) versus Q2 (SHR: 0.93-1.11). Restricted cubic spline analysis revealed a J-shaped association between SHR and outcomes, with the lowest risk observed at an SHR of approximately 1.0. CONCLUSIONS: The SHR is an independent predictor of long-term adverse outcomes in patients with AMI undergoing PCI, supporting its use for early risk stratification and glycemic management.