THE STRESS HYPERGLYCEMIA RATIO IS A MARKER FOR AN INCREASED RISK OF MYOCARDIAL ISCHEMIA-REPERFUSION INJURY AFTER MYOCARDIAL INFARCTION

Shuying Qi^{1, 2}, Zening Jin^{1, *}, Yong Zhu¹, Xiang Li¹

¹Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China - ²Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China

Background: Myocardial ischemia-reperfusion injury (MIRI) occurs frequently after acute ST-segment elevation myocardial infarction (STEMI). The predisposing factors and underlying mechanism of MIRI are not fully understood. The present study determined the correlation between the stress hyperglycemia ratio (SHR), a novel index of stress-induced hyperglycemia (SIH) and post-infarct MIRI.

Methods: A total of 776 patients with a first episode of STEMI were enrolled in this cross-sectional study. The criteria for clinical MIRI were as follows: severe reperfusion arrhythmia after percutaneous intervention (PCI) vascularization; no reflow or slow flow as thrombolysis in myocardial infarction (TIMI) flow ≤2 post-PCI; severe chest pain; ST segment abnormal elevation; and transient hypotension. Most importantly, the SHR was calculated as the admission blood glucose (ABG) level-to-the estimated average glucose level over the previous 3 months ratio.

Results: In STEMI patients with or without diabetes mellitus (DM), the SHR had a positive correlation with the peak cardiac troponin I (cTNI) level (non-DM: r=0.229, p<0.001; DM: r=0.233, p<0.001). In non-DM patients, both the SHR (beta=0.169, 95%CI 0.129 to 0.380, p<0.001) and ABG level (beta=0.116, 95%CI 0.006 to 0.040, p=0.007) were associated with MIRI unlike DM patients. Multivariate logistic regression analysis revealed that the SHR was associated with an increased risk of post-infarct MIRI in non-DM patients (OR=8.659; 95% CI, 1.895-39.568, p=0.005). Furthermore, the SHR (AUC=0.612; 95% CI, 0.570-0.653, p<0.001) had a moderate predictive value for post-infarct MIRI in non-DM patients; however, in DM patients neither the SHR nor the ABG level has predictive value for MIRI.

Conclusion: The SHR was strongly associated with an increased risk of post-infarct MIRI in patients following a STEMI. In STEMI patients without DM, the SHR was a better predictor of MIRI than the ABG level.