OBJECTIVE In recent years, some studies have indicated that a novel marker described as the stress hyperglycemia ratio (SHR) can reflect true acute hyperglycemic status and is associated with the short-term poor prognosis in patients with acute myocardial infarction. In the current study we evaluated the association of SHR with adverse cardiovascular events among patients with acute coronary syndrome (ACS). RESEARCH DESIGN AND METHODS We consecutively enrolled 5,562 ACS patients who underwent drug-eluting stent (DES) implantation. All subjects were divided into five groups according to SHR, which was determined by the following formula: ABG / [(28.7 × HbA1c %) − 46.7], where ABG is admission blood glucose level. The primary end point was major adverse cardiovascular and cerebrovascular events (MACCE) at the 2-year follow-up, and the secondary end point included major adverse cardiovascular events (MACE) at 2-year follow-up, cardiac death, and nonfatal myocardial infarction (MI) at 2-year follow-up and in-hospital cardiac death and nonfatal MI. RESULTS A total of 643 MACCE were recorded during a median follow-up of 28.3 months. Kaplan-Meier survival analysis showed the lowest MACCE incidence in quintile 3 (P < 0.001). Moreover, the outcomes of restricted cubic spline analysis suggested that there was a U-shaped or J-shaped association between the SHR and early and late cardiovascular outcomes even after adjustment for other confounding factors. CONCLUSIONS There were U-shaped associations of SHR with MACCE rate and MACE rate at 2-year follow-ups and J-shaped associations of SHR with in-hospital cardiac death and MI and that at 2-year follow-up in ACS patients who underwent DES implantation, and the inflection point of SHR for poor prognosis was 0.78.

中文翻译：

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应激性高血糖比率对急性冠脉综合征患者短期和长期预后不良的影响：来自亚洲大型队列研究的见解

目的 近年来，一些研究表明，应激性高血糖比率（SHR）是一种新的标志物，可以反映真实的急性高血糖状态，并与急性心肌梗死患者的短期预后不良有关。在目前的研究中，我们评估了急性冠状动脉综合征 (ACS) 患者中 SHR 与不良心血管事件的关系。研究设计和方法 我们连续招募了 5,562 名接受药物洗脱支架 (DES) 植入的 ACS 患者。根据SHR将所有受试者分为5组，由以下公式确定：ABG / [（28.7×HbA1c％）-46.7]，其中ABG为入院血糖水平。主要终点是2年随访时的主要不良心脑血管事件（MACCE），次要终点包括 2 年随访时的主要不良心血管事件 (MACE)、2 年随访时的心源性死亡和非致死性心肌梗死 (MI) 以及院内心源性死亡和非致死性 MI。结果 在 28.3 个月的中位随访期间，共记录了 643 例 MACCE。Kaplan-Meier 生存分析显示，五分位数 3 的 MACCE 发生率最低（P < 0.001）。此外，限制三次样条分析的结果表明，即使在调整其他混杂因素后，SHR 与早期和晚期心血管结果之间也存在 U 形或 J 形关联。