Abstract
Background Stress hyperglycemia ratio (SHR), an index of relative stress hyperglycemia, is linked to the poor clinical outcomes in patients with coronary artery disease (CAD). Nonetheless, the exploration of SHR's relationship with the prognosis of Acute Myocardial Infarction (AMI) remains scant. Therefore, this study aims to elucidate the connection between SHR and the 1-year clinical outcomes following AMI through a large cohort design analysis. Methods In this retrospective study 4012 patients who were diagnosed with AMI were consecutively enrolled from General Hospital of Ningxia Medical University(2016–2019). These patients were stratified into three distinct groups according to the tertiles of the SHR: Group T1 (SHR < 0.90, n = 1337), Group T2 (0.90 ≤ SHR < 1.11, n = 1337), and Group T3 (SHR ≥ 1.11, n = 1338). All patients were clinically followed for 1-years to collect major adverse cardiovascular events (MACEs), which included all-cause death, nonfatal myocardial infarction (MI), rehospitalization for angina, rehospitalization for heart failure (RHF) and stroke. After controlling for different confounding factors, cox regression models and restricted quadratic splines were used to investigate the relationship between SHR and 1-years clinical outcomes. Results During a 1-year follow-up, a total of 229 all-cause mortalities were record, resulting in an all-cause mortality rate of 5.71% (n = 229). Additionally, 861 MACEs were recorded, yielding a MACE rate of 21.46%. After adjusting for covariates, SHR was found to be significantly associated with 1-year MACE [hazard ratio (HR) = 2.18; 95% confidence interval (CI) = 1.64–2.89; p < 0.001] and all-cause mortality (HR = 3.11; 95% CI = 1.77–5.46; P < 0.001) in patients with AMI, and the T3 group exhibited a higher risk of 1-year MACE (HR = 1.67; 95% CI = 1.34–2.09; p < 0.001) and all-cause mortality (HR = 1.67; 95% CI = 1.02–2.73; p = 0.042) compared with T1 group. A U-shaped association was observed between SHR and 1-year MACE as well as all-cause mortality, with inflection points of 0.87 for poor prognosis in both outcomes. Conclusion SHR is significantly and positively associated with one-year clinical outcomes in patients with AMI. Furthermore, there is a specific non-linear association between SHR and MACE and all-cause mortality (both inflection point 0.87). Interventions aimed at reducing SHR levels below 0.87 through medication management have the potential to significantly improve outcomes.