Prognostic Value of Post-Procedural Stress Hyperglycemia Ratio in Patients Undergoing Percutaneous Coronary Intervention: Insights Across Glucose Metabolic Status

BackgroundThe stress hyperglycemia ratio (SHR) is a novel marker reflecting true acute hyperglycemic status and has been linked to adverse clinical outcomes in various settings. However, the clinical significance of SHR measured after percutaneous coronary intervention (PCI) remains inadequately explored. ObjectiveTo investigate the relationship between post-procedural SHR and long-term prognosis in patients with coronary artery disease (CAD). Methods and ResultsIn this prospective cohort study, a total of 7,423 patients with complete baseline data were included. Kaplan-Meier survival analysis showed significant differences in the incidence of all adverse outcomes across SHR tertiles during a 2-year follow-up (Log-rank P < 0.05). In multivariable Cox regression, patients in the highest SHR tertile had an independently increased risk of major adverse cardiovascular events (MACE) [adjusted HR (95% CI): 1.254 (1.046-1.502), P = 0.014], mainly attributable to higher risks of all-cause death [1.531 (1.076-2.177), P = 0.018] and cardiac death [1.702 (1.111-2.607), P = 0.014]. Restricted cubic spline analysis revealed a J-shaped association between SHR and the risk of MACE. Stratified analysis found that the effect of post-procedural SHR on prognosis was observed in patients with diabetes, regardless of the guideline-based criteria used to define glucose metabolism status, whereas no significant association was observed in those with normoglycemia or prediabetes. ConclusionElevated post-procedural SHR is independently associated with a higher risk of adverse cardiovascular outcomes in patients with CAD, particularly among those with diabetes. Assessment of post-procedural SHR may help refine risk stratification and guide individualized management in this population.