Predictive value of stress hyperglycemia ratio for the risk of heart failure during hospitalization in STEMI patients undergoing emergency percutaneous coronary intervention: a single-center retrospective cohort study.

BACKGROUND: Stress hyperglycemia is prevalent in acute ST-elevation myocardial infarction (STEMI) patients and associates with adverse outcomes. The stress hyperglycemia ratio (SHR), which standardizes admission glucose against estimated average glucose from HbA1c, reduces chronic glycemic interference. However, SHR's predictive value for heart failure (HF) during hospitalization following emergency percutaneous coronary intervention (PCI) remains unclear. METHODS: This single-center retrospective cohort study enrolled 1,068 consecutive STEMI patients undergoing emergency PCI from January 2020 to June 2025. SHR was calculated as the ratio of admission plasma glucose to estimated average glucose. The primary endpoint was hospitalization HF. Predictive efficacy was evaluated using multivariate logistic regression, propensity score matching (PSM), receiver operating characteristic (ROC) analysis, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). RESULTS: Overall, 158 patients (14.8%) developed hospitalization HF. The HF group showed significantly higher SHR than non-HF patients [1.52 (1.25-1.88) vs. 1.10 (0.92-1.30); P < 0.001]. Each 1-unit SHR increase associated with 2.31-fold HF risk elevation (adjusted OR=2.31, 95% CI 1.68-3.18; P < 0.001). Following 1:1 PSM, high SHR patients maintained significantly higher HF incidence (20.4% vs. 10.2%; P < 0.001). SHR's ROC area under curve was 0.748, superior to admission glucose (0.728; P = 0.031). Adding SHR yielded NRI = 0.318 and IDI = 0.035 (both P < 0.001). CONCLUSIONS: SHR independently predicts hospitalization HF in STEMI patients post-emergency PCI, demonstrating superior discriminative performance to admission glucose with significant incremental predictive value. SHR may facilitate early risk stratification and management.