| Objective: The body will enter into a stress state when suffering from fatal trauma.Under the stress state,the nerve and body fluid regulate the body to respond to protect itself from damage.During the stress state,the blood glucose will rise in a stress state.In patients with acute myocardial infarction(AMI),the prognosis of diabetes patients is worse than that of non diabetes patients.However,stress hyperglycemia has been proved to be a powerful predictor of poor prognosis,especially in patients without diabetes.This indicates that both acute and chronic elevated levels of blood glucose can predict the prognosis of patients.The level of chronic elevated blood glucose in patients with AMI cannot be determined,but it can be estimated by evaluating the value of glycosylated hemoglobin(Hb A1c).Therefore,in patients with acute myocardial infarction,the combined information provided by acute(measured at admission)and chronic(glycosylated hemoglobin estimation)blood glucose values may be a better predictor of prognosis than blood glucose values at admission alone or in the state of diabetes.The Stress Hyperglycemia Ratio(SHR)is the admission glucose divided by the estimated average glucose calculated by glycosylated hemoglobin.It represents the "real" acute hyperglycemia and can more accurately identify and quantify stress hyperglycemia.In this study,the aim was to explore the relationship between the the stress hyperglycemia ratio and the incidence of major adverse cardiovascular events(MACEs)in patients with AMI and treated by percutaneous coronary intervention(PCI).To evaluate whether the stress hyperglycemia ratio can predict the adverse outcome of patients with AMI who received PCI for coronary artery disease.Methods: This study is a retrospective study,involving 855 patients with AMI and treated by PCI in the Lianhe Road Hospital Area and the Jinpu Hospital Area of the First Affiliated Hospital of Dalian Medical University from January 1,2021 to December 31,2021.All patients were draw venous blood within 24 hours of admission to obtain fasting blood glucose and glycosylated hemoglobin values,and collected basic medical history information after admission.The patients with AMI and treated by PCI were followed up by telephone or electronic case system,and the main adverse cardiovascular events(MACE)were located as the end point of the follow-up event to follow up the occurrence of major adverse cardiovascular events in patients with AMI and treated by PCI.After the follow-up,the patients were divided into event group and no event group according to whether the patients occurred to major cardiovascular adverse events.Considering that the indicators in this study are blood glucose related indicators,the impaired blood glucose metabolism of patients with diabetes may affect the results,so according to whether the patients included in the data have diabetes,the patients were divided into diabetes group and non diabetes group,compare the difference of blood glucose indexes between the event group and the non event group in the diabetes group and the non diabetes group.In order to explore the impact of the stress hyperglycemia ratio on the occurrence of major cardiovascular adverse events,the patients in the diabetes group and the non diabetes group were divided into four groups using the quartile method,and the occurrence of each major cardiovascular adverse event was compared.In order to evaluate the predictive effect of three blood glucose indicators,including admission blood glucose,glycosylated hemoglobin,and the stress hyperglycemia ratio on the occurrence of major adverse cardiovascular events in patients with AMI and treated by PCI,the three indicators of admission blood glucose,glycosylated hemoglobin,and the stress hyperglycemia ratio were included in the receiver operating characteristics(ROC)working curve,and the stress hyperglycemia ratio and admission blood glucose were compared the value and difference of blood glucose indicators such as glycosylated hemoglobin in predicting the prognosis and prognosis of patients with AMI and treated by PCI.To explore the influence of the high and low ratios of acute and chronic blood glucose on the major adverse cardiovascular events in patients with AMI and treated by PCI,the patients was divided into high and low groups according to the median of stress hyperglycemia ratio,the major adverse cardiovascular events were taken as the endpoint event,then the Kaplan-Meier method was used to draw the survival curve to explore the influence of the stress hyperglycemia ratio of patients with AMI and treated by PCI combined with diabetes and non diabetes on the time dimension of major cardiovascular adverse events.Results: In the comparison of baseline data of all patients included in the study,the numbers of patients with diabetes(P<0.001),history of myocardial infarction(P<0.001),killip grade(P<0.001),heart rate(P<0.001),left ventricular ejection fraction(P<0.001),hemoglobin(P=0.027),high-density lipoprotein(P<0.001),admission blood glucose(P<0.001),glycosylated hemoglobin(P<0.001),Diabetes(OR=1.924),history of MI(OR=3.022),and stress hyperglycemia ratio(OR=2.912)are risk factors affecting the prognosis of patients with AMI and treated by PCI,whereas HDL level(OR=0.291)is a protective factor for the prognosis of patients with AMI and treated by PCI.No matter whether the patient is complicated with diabetes or not,the admission blood glucose and stress hyperglycemia ratio are significantly different between the event group and the non event group(P<0.001).After grouping the quartile of the stress hyperglycemia ratio of the patient,no matter whether the patient is complicated with diabetes or not,The incidence of MACE(including all-cause mortality,in-hospital MACE incidence,and cardiac re-admission rate)in the high-quartile group of acute and chronic blood glucose ratio was higher than that in the other three groups,indicating that patients with AMI and treated by PCI with high SHR had a worse prognosis.Both admission blood glucose and stress hyperglycemia ratio were significantly correlated with the long-term MACE in patients with AMI and treated by PCI(P<0.001).The receiver operating characteristic(ROC)curve of three blood glucose indicators,including admission blood glucose,Hb A1 c,and stress hyperglycemia ratio,showed that the stress hyperglycemia ratio was more advantageous in predicting the long-term prognosis of patients with AMI and treated by PCI(AUC=0.786,P<0.001).Patients with diabetes and non diabetes were divided into SHR median groups and survival curves were made by Kaplan-Meier method.The results showed that there was a significant difference between the high and low quantiles of SHR(log rank P<0.001),regardless of whether patients with diabetes or not,and the survival rate of the high quantile group of SHR was lower than that of the low quantile group.Conclusion: The stress hyperglycemia ratio is an important indicator to predict the long-term prognosis of patients with AMI and treated by PCI.Compared with admission blood glucose,the stress hyperglycemia ratio is better to reflect the degree of stress increase of blood glucose after trauma,and has more advantages in predicting the long-term prognosis of patients with AMI and treated by PCI. |
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