ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Cardiovascular Endocrinology
This article is part of the Research TopicPrognostic Value of Inflammatory and Thrombotic Biomarkers in Acute Coronary SyndromeView all 7 articles
Impact of stress hyperglycemia ratio on incidence of in-hospital cardiogenic shock in patients with ST-elevation myocardial infarction: a prospective, multicenter study
Provisionally accepted
- 1Department of Cardiology, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Heart Center of Henan Provincial People’s Hospital, Zhengzhou, China
- 2Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Background: The stress hyperglycemia ratio (SHR) has emerged as a valuable prognostic indicator in patients with ST-elevation myocardial infarction (STEMI). Nevertheless, the impact of SHR on the incidence of in-hospital cardiogenic shock (IHCS) remains insufficiently explored in patients with STEMI. This study aimed to investigate the association between SHR and IHCS incidence while assessing its additional predictive value beyond established risk scores. Methods: Data were derived from a prospective, multicenter registry and included 1776 patients with STEMI. Patients were grouped by the optimal cutoff value of SHR. The primary endpoint was the incidence of IHCS. Generalized linear mixed models, restricted cubic splines (RCS), ROC curves, and decision curve analysis (DCA) were utilized, with feature importance assessing its importance. Results: The IHCS incidence was notably higher in patients with elevated SHR. RCS analysis indicated a significant dose-response relationship between increasing SHR and IHCS risk (P-Nonlinear > 0.05). SHR was independently associated with IHCS in the overall population (OR: 2.19, 95% CI: 1.20-4.00) and in patients without diabetes (OR: 2.20, 95% CI: 1.11-4.35). Incorporating SHR into established risk scores significantly improved predictive accuracy and net clinical benefit. SHR was comparably important in predicting IHCS compared to established risk factors. Conclusions: Elevated SHR is a valuable predictor and manifests additional predictive value beyond established risk scores in predicting IHCS in patients with STEMI, especially among patients without diabetes.
Keywords: Stress hyperglycemia ratio, ST-elevation myocardial infarction, in-hospital cardiogenic shock, Diabetes Mellitus, Multicenter study
Received: 31 Jul 2025; Accepted: 27 Nov 2025.
Copyright: © 2025 Wang, Zhang, Yang, Wang, Zhu, Qi, Zhang, Zhang and Gao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Chuanyu Gao
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