Effect Of Stress Hyperglycemia Ratio On Prognosis In Patients With Acute Coronary Syndrome

Objective:In patients with critically ill were often accompanied by stress hyperglycemia,which had a risky of poor prognosis.Many previous studies had showed that plasma glucose aboved a certain level to be considered stress hyperglycemia.However,plasma glucose was easily affected by diet and chronic hyperglycemia,so the method of predicting stress hyperglycemia was not reliable.Gradually,stress hyperglycemia ratio was recognized.In this study,the main idea was to explore whether the stress hyperglycemia ratio was an independent risk factor of the major cardiovascular adverse events（MACE）in patients with acute coronary syndrome,and to find the optimal cutoff value.Furthermore,whether the stress hyperglycemia ratio was superior to plasma glucose,for predicting stress hyperglycemia.Methods:This is a retrospective study.Patients with acute chest pain were diagnosed as acute coronary syndrome during October 2017 and May 2018 were recruited.A total of 317 patients were enrolled,including 124 cases of acute ST-segment elevation myocardial infarction（STEMI）and 193 cases of non-ST-segment elevation acute coronary syndrome（NSTE-ACS）.Males were 227,accounting for 71.6%,while females were 90,accounting for 28.4%.And the average year-old was（63.00±12.58）.Diabetes were 162,accounting for 51.1%.The stress hyperglycemia ratio（SHR）was calculated according to the first fasting plasma glucose and glycosylated hemoglobin within 24 hours after admission.According to the median of SHR,the patients were divided into high SHR group and low SHR group.Collected basic clinical information of patients by reviewing case data,including gender,age,body mass index（BMI）,hypertension,diabete,prior coronary heart disease,prior stroke,admission heart rate,systolic blood pressure,diastolic blood pressure,discharge diagnosis,primary PCI,coronary angiography,number of lesions,number of stents,Killip grade,ejection fraction and biochemical tests（plasma glucose,glycated hemoglobin,total cholesterol,triglycerides,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol）in the first 24-hour fasting condition.The statistical software SPSS 23.0 was used to analyze,and the clinical characteristics between the high SHR and low SHR were compared in samples of all patients and diabetic patients.Univariate and multivariate logistic regression were used to calculate odds ratio（OR）and its 95%confidence interval（CI）.The Receiver operating characteristic（ROC）curve was analyzed and compared using Medcalc software.Results:1.All patients of acute coronary syndrome（1）Compared with the low SHR group,the high SHR group had higher fasting plasma glucose,more stress hyperglycemia,and a serious condition.For example,more diagnoses with acute ST-segment elevation myocardial infarction and weaken wall motion,lower ejection fraction,and more MACE（including heart failure,death,non-fatal reinfarction,and non-fatal stroke）（P<0.05）.1.2 High SHR was an independent risk factor for major adverse cardiovascular events（death,non-fatal reinfarction,non-fatal stroke,heart failure）.The risky of major adverse cardiovascular events in the high SHR group was 3.187 times in hospital compared with the low SHR group（adjusted OR=2.420,95%CI 1.129-5.186,P=0.023）.1.3 In addition to high SHR,age more than 65 years（OR=2.635,95%CI1.273-5.452,P=0.009）and STEMI（OR=3.723,95%CI 1.788-7.751,P<0.001）were independent risk factors of MACE in hospital,while men,smoking,high blood pressure and diabete history were not.1.4 ROC curve obtained the optimal cutoff value of SHR and fasting plasma glucose when predicting the occurrence of MACE.The results showed that the AUC _SHR=0.712（95%CI 0.659-0.762,P<0.001）and the AUC _{fasting plasma glucose}=0.701（95%CI 0.647-0.751,P<0.001）.The both had a potential predictive value of stress hyperglycemia.The optimal cut-off of SHR was 0.987,and the cut-off of fasting plasma glucose was 6.98 mmol/L.The ROCs between fasting plasma glucose and SHR comparison by Medcalc software was not difference（P=0.695）.2.Diabetics of acute coronary syndrome2.1 In diabetic patients,the high SHR group had more stress hyperglycemia and serious condition.They had more diagnoses with STEMI and weaken wall motion,lower ejection fraction,and more MACE（including heart failure,death,non-fatal reinfarction,and non-fatal stroke）（P<0.05）.2.2 High SHR was an independent risk factor of major adverse cardiovascular events in hospital（adjusted OR=4.337,95%CI 1.542-12.196,P=0.005）.In addition to high SHR,STEMI was also an independent risk factor（OR=3.168,95%CI1.243-8.078,P=0.016）.2.3 The ROC curve obtained the optimal cutoff value of SHR and fasting plasma glucose in the set of diabetic patients of ACS when predicting the occurrence of MACE.The results showed that the AUC _SHR=0.759（95%CI 0.685-0.822,P<0.001）,and the AUC _{fasting plasma glucose}=0.679（95%CI 0.602-0.750,P<0.001）.The both had a potential predictive value of stress hyperglycemia.The cutoff values of SHR and fasting plasma glucose were respectively 0.987 and 9.54 mmol/L.Using Medcalc to compare the ROC curves between fasting plasma glucose and SHR,SHR was significantly superior to fasting plasma glucose（P=0.034）.Conclusion:The stress hyperglycemic ratio is an independent risk factor of major cardiovascular adverse events in ACS patients.SHR is not affected by chronic plasma glucose levels.The optimal cut-off of SHR is 0.987 in all patients or diabetics.It may be used as a diagnostic indicator of stress hyperglycemia.For serious illness with stress hyperglycemia,lower SHR may be used as a glucose control standard.In the future,we should pay attention to stress hyperglycemic ratio to help identify high-risk patients earlier.