The Role of SHR in Risk Stratification for Long-Term Prognosis in Patients with Coronary Artery Disease: Findings from a Large Cohort Study

Wei Xu¹Xiang Wang²Chenxi Xia²Xuyang Meng²Yi Li²Yejing Zhao²Chenguang Yang²Baoyu Feng^3*Zinan ZHAO^2*Fang Wang^2*

• ¹Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Beijing, China
• ²Beijing Hospital, Peking University, Beijing, China
• ³Capital Medical University, Beijing, China

Background: Recently, the Stress Hyperglycemia Ratio (SHR) -which integrates acute increases in blood glucose with long-term glycemic control levels -has shown independent predictive value for adverse events in patients with acute coronary syndrome (ACS). However, the long-term prognostic significance of SHR in a broader population of coronary artery disease (CAD) remains unclear. This study aimed to explore the role of SHR in prediction of long-term prognosis of CAD.In this cohort study, we enrolled 23,591 participants diagnosed with CAD from January, 2016, to December, 2021 in Beijing Hospital. After excluding patients lacking data, with cancers, or missing follow-ups, 7,162 patients were finally enrolled into the analyses. The SHR was calculated using the following equation: SHR = admission glucose (mmol/L)/(1.59 × HbA1c [%]-2.59). The 7,162 participants were divided into three groups based on SHR tertiles: Tertile 1 (SHR≤0.72, n=2391), Tertile 2 (0.73≤SHR≤0.82, n=2388), and Tertile 3 group (SHR≥0.83, n=2383). The primary endpoint was all-cause mortality and cardiovascular death (CVD), while the second endpoint was major adverse cardiovascular events (MACE).The median follow-up was 28 months.Our results suggest that SHR was significantly associated with increased risks of longterm all-cause death, CVD death, and MACE. The Kaplan-Meier curves revealed that the highest tertile (T3) group had the highest risk of all-cause death , CVD death, and MACE, while Conclusions: SHR is significantly associated with long-term all-cause death, CVD death, and MACE in CAD patients. Our findings highlight SHR can be used as a valuable tool for longterm prognosis risk stratification in CAD, potentially influencing clinical decision-making and patient management strategies. Keywords： coronary artery disease, stress hyperglycemia ratio, all-cause death， cardiovascular disease death, major adverse cardiovascular events.