Effect of stress-induced hyperglycaemia on clinical outcome in paitients with acute ST-segment elevation myocardial...

Stress hyperglycemia (SHG) is a transient glycemic disturbance induced by acute stress, and its independent prognostic value in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) remains to be fully clarified. This study aimed to investigate the impact of SHG on short- and long-term outcomes in this population and evaluate its role in risk stratification.

A retrospective analysis was conducted on 818 first-time STEMI patients who underwent emergency PCI between July 2020 and February 2024. Patients were classified into three groups based on diabetes history, fasting blood glucose (FBG) levels, and glycated hemoglobin (HbA1c) levels: 1) SHG group (n = 200): Non-diabetic patients with FBG ≥7.0 mmol/L and HbA1c < 6.5%; 2) Non-SHG group (n = 319): Non-diabetic patients with FBG <7.0 mmol/L and HbA1c < 6.5%; 3) Diabetes group (n = 299): Patients with HbA1c ≥ 6.5% or previously diagnosed diabetes. Major adverse cardiovascular events (MACE) were compared during hospitalization and at one-year follow-up. A multivariate logistic regression model was used to assess the independent association of SHG with in-hospital prognosis, and a Cox proportional hazards model was applied for one-year outcomes.

The SHG group had significantly higher in-hospital all-cause mortality (IHACM; 13.4% vs. 2.19% in the non-SHG group, P < 0.001), and Multivariate logistic regression analysis confirmed SHG as the strongest independent risk factor for IHACM (OR = 4.68, 95% CI: 1.98-11.04). At one year, the SHG group showed higher mortality (14.9% vs. 3.76%) and heart failure incidence (26.0% vs. 12.23%, P < 0.05) compared with the non-SHG group. However, long-term mortality was primarily associated with Killip classification (HR = 4.67, 95% CI: 2.68-8.15) and coronary artery disease severity (Gensini score, HR = 1.05, 95% CI: 1.03-1.07).

SHG is a strong independent risk factor for IHACM in STEMI patients, with potential mediation by acute metabolic disorders and endothelial injury. Notably, acute hemodynamic instability cannot be excluded as a contributing factor to the observed association, and further studies are needed to clarify the precise mediating pathways. Long-term prognosis is mainly influenced by baseline cardiac function and coronary artery disease severity. Incorporating SHG (defined as FBG ≥7.0 mmol/L in non-diabetic patients with HbA1c < 6.5%) into early risk stratification and developing individualized management strategies for acute-phase glucose fluctuations are recommended.