Fasting stress hyperglycemia ratio independently predicted intramyocardial hemorrhage with an adjusted OR of 1.21 per 0.1-unit increase in STEMI patients treated with PPCI.
Cohort (n=496)
Yes
Does elevated fasting stress hyperglycemia ratio predict intramyocardial hemorrhage and major adverse cardiac events in STEMI patients undergoing primary PCI?
Fasting stress hyperglycemia ratio is a strong, independent predictor of intramyocardial hemorrhage and long-term major adverse cardiac events in patients with reperfused STEMI.
Effect estimate: adjusted OR 1.21 per 0.1-unit increase in fasting SHR (95% CI 1.10–1.33)
p-value: p=<0.001
Introduction Intramyocardial hemorrhage (IMH) represents the most severe form of microvascular injury and is associated with poor prognosis in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI). However, the associations of glycemic parameters with the occurrence of IMH remain unclear. We aimed to evaluate the association of fasting stress hyperglycemia ratio (SHR)—a novel metric that adjusts acute glucose for chronic glycemia—with the presence of IMH and to explore its relationship with clinical outcomes in patients with STEMI. Methods This study utilized data from the prospective, multicenter EARLY-MYO-CMR registry (NCT03768453). We enrolled consecutive STEMI patients undergoing PPCI who had cardiac magnetic resonance (CMR) imaging within a week after the index infarction. The primary endpoint was the presence of IMH defined by CMR T2* mapping. A secondary clinical endpoint was the composite of major adverse cardiac events (MACE) during follow-up. Results Among the 496 patients included in this study, 205 (41.3%) exhibited IMH. Multivariable analysis identified fasting SHR as the strongest independent predictor of IMH (adjusted odds ratio aOR per 0.1-unit increase: 1.21; 95% CI: 1.10–1.33, P0.001), outperforming fasting blood glucose and HbA1c. This association was consistent in both non-diabetic (aOR: 1.27; P=0.001) and diabetic patients (aOR: 1.21; P=0.015). Restricted cubic spline analysis revealed a significant nonlinear relationship (P for nonlinearity=0.004), characterized by a rapid increase in IMH risk at lower SHR levels, where the study population was primarily concentrated, and remained consistently high thereafter. During a median follow-up of 25 months, elevated fasting SHR was significantly associated with an increased risk of MACE (Unadjusted hazard ratio per 0.1-unit increase: 1.20; 95% CI: 1.11–1.31; P0.001; adjusted hazard ratio per 0.1-unit increase:1.20; 95% CI: 1.09–1.31; P0.001), with Kaplan-Meier analysis confirming a significantly higher cumulative incidence of MACE in the high SHR group (log-rank P0.001). Discussion Fasting SHR was a potent, independent predictor of IMH in reperfused STEMI. Notably, the IMH risk escalates rapidly even at lower SHR levels, underscoring the critical need for early management of stress hyperglycemia. Elevated SHR was significantly associated with increased risk of MACE. These findings establish fasting SHR not only as a biomarker for microvascular injury but also as a pivotal tool for early risk stratification in STEMI.
Zhao et al. (Wed,) conducted a cohort in Adults with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) (n=496). Fasting stress hyperglycemia ratio (SHR) vs. Lower SHR levels was evaluated on Presence of intramyocardial hemorrhage (IMH) defined by cardiac magnetic resonance (CMR) T2* mapping within 1 week post PPCI (adjusted OR 1.21 per 0.1-unit increase in fasting SHR, 95% CI 1.10–1.33, p=<0.001). Fasting stress hyperglycemia ratio independently predicted intramyocardial hemorrhage with an adjusted OR of 1.21 per 0.1-unit increase in STEMI patients treated with PPCI.