Critical Care and Shock

Stress hyperglycemia ratio and its association with outcomes among patients admitted with ST-segment elevation myocardial infarction (STEMI) in Coronary Care Unit: An observational prospective study

Abstract

Background: Patients with acute myocardial infarction (MI) frequently have elevated blood glucose levels at the time of admission to the hospital. Admission hyperglycemia and relative hyperglycemia adversely impact cardiovascular outcomes among patients with MI.

Objective: This study aimed to assess the stress hyperglycemia ratio (SHR) and its association with in-hospital complications and mortality among patients with ST-segment elevation myocardial infarction (STEMI).

Design and setting: A prospective study was conducted in the Coronary Care Unit (CCU) between May 2019 and April 2020.

Patients and participants: This study was conducted among 152 patients hospitalized with STEMI in the CCU between May 2019 and April 2020. Based on the SHR, patients were categorized into three groups: Group 1 included SHR≤1.0, Group 2 included SHR 1.01 to 1.25, and Group 3 included SHR≥1.26. Patients enrolled were followed until discharge from the hospital or death. Outcome and in-hospital complications were compared across the three groups. Stress hyperglycemia ratio and admission blood glucose (in mg/dl) cut-off predicting the major adverse events (MAE) studied with the highest sensitivity and specificity was calculated using the receiver operating characteristic (ROC) curve.

Results: Among 152 studied patients, the majority were males (n=109, 71%). Seventy-four patients with SHR≥1.26 (Group 3) had significantly higher thrombolysis in myocardial infarction (TIMI) scores (p value<0.0001). One hundred thirty-nine patients survived; non-survivors were 13, with an observed mortality rate of 8.5%. SHR among STEMI patients was significantly associated with death, acute kidney injury requiring dialysis, and atrioventricular block (p value=0.043, p value=0.04, p value=0.037, respectively). SHR cut-off of 1.36 had a sensitivity 73.3% and specificity 73.8% in predicting MAE (AUC-0.8, p value=0.0005). Admission blood glucose of 260 mg/dl had a sensitivity 66.4% and specificity 66.7% in predicting MAE (AUC-0.7, p value=0.0005).

Conclusion: SHR is a good prognostic marker in predicting death and adverse cardiovascular outcomes among patients with acute MI. SHR had better predictive superiority than admission blood glucose in prognostication of major adverse events among patients with STEMI.