Shuai Wang, Jiatong Li, Shan Xie, Qicheng Yu, Haodong Jiang, Wenliang Zhai, Yanling Wang, Zhenxing Fan, Zhi Liu
In this retrospective cohort, elevated admission SHR was independently and nonlinearly associated with ATO. Although SHR may complement clinical assessment, further external validation is required before clinical implementation.
BACKGROUND: Acute total occlusion (ATO) of the culprit artery identifies a high-risk subgroup of patients with non-ST-segment elevation myocardial infarction (NSTEMI), but its early recognition remains challenging. The stress hyperglycemia ratio (SHR) reflects acute glycemic elevation relative to chronic glycemic status. This study investigated the association between admission SHR and ATO in patients with NSTEMI.
METHODS: This retrospective, single-center observational cohort study included 827 consecutive patients with NSTEMI who underwent coronary angiography between January 2017 and December 2023. SHR was calculated from fasting plasma glucose and glycated hemoglobin measured at admission. ATO was defined as Thrombolysis in Myocardial Infarction flow grade 0 or 1 in the culprit artery. Receiver operating characteristic analysis was used to assess the discriminatory performance of SHR, and multivariable logistic regression and restricted cubic spline analyses were performed to evaluate its independent and nonlinear associations with ATO.
RESULTS: In the overall cohort, SHR showed greater discriminatory performance for ATO (area under the curve, 0.743; 95% confidence interval [CI], 0.708-0.777) than fasting plasma glucose (FPG) (0.706; 95% CI, 0.670-0.742) or glycated hemoglobin (HbA1c) (0.571; 95% CI, 0.531-0.612). The optimal SHR cutoff was 0.903. After multivariable adjustment, SHR >0.903 remained independently associated with higher odds of ATO (adjusted odds ratio, 5.09; 95% CI, 3.66-7.06; P<0.001). Restricted cubic spline analyses further demonstrated significant overall and nonlinear associations between SHR and ATO, which remained robust after covariate adjustment and restriction to the 1st-99th percentile range (all P<0.001).
CONCLUSION: In this retrospective cohort, elevated admission SHR was independently and nonlinearly associated with ATO. Although SHR may complement clinical assessment, further external validation is required before clinical implementation.