Prognostic Implication of Stress Hyperglycemia in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Background: Previous studies have reported that stress hyperglycemia is associated with adverse outcomes in hospitalized patients. We aimed to investigate the association between a novel index of stress hyperglycemia and the risk of mortality in acute coronary syndrome (ACS) patients who underwent percutaneous coronary intervention (PCI). Methods This cohort study consisted of 5,316 ACS patients who underwent PCI from the Cardiovascular Center Beijing Friendship Hospital Database Bank (CBDBANK) from January 2013 to January 2021. Stress hyperglycemia was defined by the glucose/glycated albumin (GA) ratio, calculated as admission fasting plasma glucose divided by GA. The patients were divided into four groups according to glucose/GA ratio quartiles (Q1-Q4). Cox proportional hazards regression and restricted cubic spline were used to evaluate the association between glucose/GA ratio and all-cause and cardiovascular (CV) mortality. Results During a median follow-up of 4.0 years, 322 (6.1%) all-cause deaths and 180 (3.4%) CV deaths were reported. After adjustment for potential confounders, the risk of all-cause mortality increased in both the lowest (HR, 1.43; 95% CI, 1.01–2.01) and highest (HR, 1.53; 95% CI, 1.05–2.21) glucose/GA ratio quartiles as compared that of Q2. The restricted cubic splines showed that the association between glucose/GA ratio and all-cause mortality was J-shaped after full adjustment ( P nonlinear = 0.010). Similar results were observed for CV deaths. In subgroup analyses, the J-shaped relationship was only significant in patients with diabetes mellitus. Conclusion In ACS patients undergoing PCI, both low and high glucose/GA ratio levels were associated with an increased all-cause and CV mortality, especially in those with diabetes mellitus.