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Association Between Stress Hyperglycemia Ratio and Cardiovascular Outcomes in Patients Who Underwent Complex

Jining He1,2,3, Zhangyu Lin1,2,3, Chenxi Song1,2,3

  • 1Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.

Journal of the American Heart Association
|July 3, 2026
PubMed

Insights

Elevated stress hyperglycemia ratio (SHR) predicts worse cardiovascular outcomes after complex percutaneous coronary intervention. This risk is particularly high for diabetic patients, aiding in risk stratification.

Area of Science:

  • Cardiology
  • Endocrinology
  • Public Health

Background:

  • Complex percutaneous coronary intervention (PCI) carries a higher risk of adverse cardiovascular outcomes compared to non-complex procedures.
  • Stress hyperglycemia ratio (SHR) is a biomarker for relative hyperglycemia, known to predict cardiovascular events in coronary artery disease patients.
  • The prognostic value of SHR in patients undergoing complex PCI, a high-risk group, remained unclear.

Purpose of the Study:

  • To investigate the association between SHR and long-term cardiovascular event risk in patients undergoing complex PCI.
  • To determine if SHR can serve as a prognostic marker in this specific high-risk patient population.

Main Methods:

  • A prospective cohort study included 12,220 patients undergoing complex PCI between January 2017 and December 2018.
  • Patients were stratified into three baseline SHR tertiles (T1: ≤0.765, T2: 0.765-0.879, T3: >0.879).
  • The primary endpoint comprised cardiovascular events, including cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke, over a median 3-year follow-up.

Main Results:

  • A total of 389 cardiovascular events were recorded among 10,772 patients who completed follow-up.
  • Each one-unit increase in SHR was associated with a 1.62-fold increased risk of cardiovascular events after adjusting for confounders.
  • Elevated SHR (T3 vs. T1) significantly increased cardiovascular event risk in diabetic patients (HR, 1.67) in fully adjusted models.

Conclusions:

  • Elevated SHR levels are linked to increased long-term cardiovascular event risk in patients following complex PCI.
  • SHR is a valuable tool for risk stratification and prognosis, especially in diabetic patients who underwent complex PCI.
  • These findings highlight the importance of monitoring SHR in high-risk cardiovascular patients.
Abstract

Keywords:
complex coronary artery diseasecomplex percutaneous coronary interventiondiabetesstress hyperglycemia ratio

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