Impact of Stress Hyperglycemia Ratio on Long-term Clinical Outcomes in Patients Undergoing Coronary Artery Bypass Grafting

Abstract

Stress Hyperglycemia Ratio (SHR) has been established as significantly associated with adverse cardiovascular clinical outcomes. However, the correlation between SHR and long-term major adverse cardiovascular events (MACEs) in patients undergoing coronary artery bypass grafting (CABG) has not been reported. The present retrospective study enrolled 2412 patients with Coronary Artery Disease (CAD) post-CABG from April 2011 to December 2020 at the Second Xiangya Hospital of Central South University. Multivariable-adjusted Cox proportional hazard models and restricted cubic spline analysis were utilized to investigate the relationship between the SHR and MACEs and their subtypes. Furthermore, the incremental predictive value of the SHR was evaluated. Over a median follow-up period of 4.4 years, 619 patients (25.6%) experienced MACEs. Multivariable analysis identified SHR as an independent risk factor for the occurrence of MACEs and individual events. Restricted cubic spline analysis demonstrated a connection between SHR and the occurrence of MACEs and individual events. Receiver Operating Characteristic (ROC) analysis revealed that the predictive ability of SHR for MACEs and subtypes was consistent in patients with and without diabetes. Incorporating SHR into a traditional risk model for MACEs enhanced the C-statistics, net reclassification improvement value, and integrated discrimination improvement value.