Prognostic value of stress hyperglycemia ratio in patients with acute myocardial infarction: A systematic review with Bayesian and frequentist meta-analysis

The present systematic review and meta-analysis aimed to investigate the prognostic value of stress hyperglycemia ratio (SHR) in patients with acute myocardial infarction (AMI). A total of 26 cohort studies, involving 87974 patients, were analyzed. The frequentist meta-analysis showed that AMI patients with SHR in the upper quantile had a significantly higher hazard of major adverse cardiovascular and cerebrovascular events (MACCE, HR = 1.7; 95% CI= [1.42, 2.03]; P< 0.001; I2= 71%; P <0.01), long-term (HR = 1.64; 95% CI= [1.49, 1.8]; P< 0.001; I2= 16%; P= 0.29) and in-hospital all-cause mortality (OR = 3.87; 95% CI= [2.98, 5.03]; P< 0.001; I2= 54%; P= 0.03) compared to those with lower SHR. Prespecified subgroup analyses revealed that these results were consistent irrespective of diabetes status (P= 0.32 and 0.73 for subgroup differences) and that SHR was a significant predictor of MACCE both in AMI with obstructive coronary arteries (HR = 1.57; 95% CI= [1.34, 1.83]; P< 0.001; I2= 66%; P< 0.01) and MINOCA (HR = 2.57; 95% CI= [1.86, 3.56]; P< 0.001; I2= 0%; P= 0.84). The Bayesian analyses with weakly prior assumptions yielded comparable results with the frequentist approach and provided strong evidence that higher SHR values were associated with significantly greater hazard of MACCE, short-term and long-term mortality. Further, prospective research is warranted to provide deeper insights into this newer index of stress hyperglycemia before its potential incorporation in clinical prediction scores.