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Relative Hyperglycemia and In-Hospital Bleeding Across Glycemic Status in Patients on High-Intensity Antithrombotic

Chong Zhang1,2,3, Junxiang Liu4, Wennan Liu1

  • 1Department of Cardiology, Tianjin Medical University General Hospital.

Circulation Journal : Official Journal of the Japanese Circulation Society
|June 8, 2025
PubMed

Insights

A high stress hyperglycemia ratio (SHR) independently predicts major bleeding after percutaneous coronary intervention (PCI), especially in patients with pre-diabetes mellitus (Pre-DM). Early medical therapy can reduce this bleeding risk.

Area of Science:

  • Cardiology
  • Endocrinology
  • Clinical Research

Background:

  • Relative hyperglycemia, indicated by the stress hyperglycemia ratio (SHR), is associated with adverse outcomes in acute coronary syndrome (ACS).
  • The link between SHR and bleeding risk post-percutaneous coronary intervention (PCI) in patients with varying glycemic statuses is not well understood.

Purpose of the Study:

  • To investigate the association between SHR and in-hospital major bleeding risk after PCI.
  • To examine this association across different glycemic statuses (diabetes mellitus, pre-diabetes mellitus, normal glucose regulation).

Main Methods:

  • Analysis of ACS patients undergoing PCI from the CCC-ACS registry and THMDP cohort.
  • SHR calculated from admission fasting blood glucose and hemoglobin A1c.
  • Primary outcome: in-hospital major bleeding.

Main Results:

  • A high SHR (>1.0) was an independent predictor of major bleeding post-PCI in the total cohort (aOR 1.51).
  • The highest bleeding risk associated with high SHR was observed in the pre-diabetes mellitus group (aOR 1.98).
  • Findings were validated in an external cohort; guideline-directed medical therapy reduced bleeding risk.

Conclusions:

  • Elevated SHR is an independent risk factor for in-hospital major bleeding after PCI, particularly in patients with pre-diabetes mellitus.
  • Further research and clinical trials are warranted to explore SHR-targeted therapies for pre-diabetes mellitus patients.
Abstract

Keywords:
Acute coronary syndromeGlycemic statusMajor bleedingPercutaneous coronary interventionStress hyperglycemia ratio

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