The stress hyperglycemia ratio, an index of relative hyperglycemia, as a predictor of clinical outcomes after percutaneous coronary intervention

Int J Cardiol. 2017 Aug 15;241:57-63. doi: 10.1016/j.ijcard.2017.02.065. Epub 2017 Feb 22.


Background: We aimed to investigate the outcome-predicting value of a novel index of stress hyperglycemia in coronary artery disease (CAD) patients who underwent percutaneous coronary intervention (PCI).

Methods: This was a retrospective observational study. Four-thousand-three-hundred-sixty-two subjects from the COACT registry were used to estimate the risk of major adverse cardiovascular and cerebrovascular events (MACCE), which are defined as composites of all-cause death, non-fatal myocardial infarction (MI) and non-fatal stroke. The stress hyperglycemia ratio (SHR) was calculated by dividing the random serum glucose at admission with the estimated average glucose derived from HbA1c.

Results: Over a median follow-up of 2.5years, 344 (7.9%), 43 (1.0%), and 89 (2.0%) cases of death, non-fatal MI, and non-fatal stroke occurred, respectively. Compared with the subjects in the lower three quartiles of SHR, the HR (95% CI) for the highest SHR quartile (Q4) group for MACCE was 1.31 (1.05, 1.64) in the total population and 1.45 (1.02, 2.06) in the non-diabetic population after adjusting for potential covariables. The risk of MACCE in the SHR Q4 group was significantly higher in patients presenting with ST-elevation MI (STEMI), which was not the case for patients presenting with other CAD types. The prognostic impact of SHR was more prominent for the 30-day MACCE. Similar results were observed in another cohort consisting of patients who only presented with acute MI.

Conclusions: SHR is a useful predictive marker of MACCE after PCI, especially in non-diabetic patients with STEMI, which could be utilized to identify high-risk patients for adverse outcomes.

Keywords: Coronary artery disease; Diabetes; Major adverse cardiovascular and cerebrovascular events; Percutaneous coronary intervention; Stress hyperglycemia ratio.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Blood Glucose / metabolism*
  • Coronary Artery Disease / blood*
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Hyperglycemia / blood*
  • Hyperglycemia / diagnosis
  • Hyperglycemia / surgery*
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention / trends*
  • Predictive Value of Tests
  • Registries
  • Retrospective Studies
  • Treatment Outcome


  • Blood Glucose