Stress hyperglycemia ratio and albumin predict in-hospital outcomes in patients with acute myocardial infarction: a cohort study

Elevated stress hyperglycemia ratio (SHR) is a putative risk indicator for acute myocardial infarction (AMI). However, the relationship between SHR, albumin, and subsequent cardiovascular adverse outcomes is less well-established. We consecutively included patients from a multi-center, prospective registry (NCT05337319) from January 2022 to October 2023 and analyzed their baseline SHR and albumin levels. Low and high SHR were determined using the optimal cutoff value. The primary outcome was in-hospital major adverse cardiovascular events, which were composed of all-cause mortality, cardiac shock, acute congestive heart failure (ACHF), reinfarction, and stroke. Multivariable logistic regression models were used to estimate albumin-stratified associations between SHR and outcomes. A total of 5269 patients presenting with AMI were included, of which 27.7% were high-SHR and 19.5% had hypoalbuminemia. Low-SHR normalbuminemia had the lowest in-hospital MACEs (1.4%), with which as the reference, high-SHR hypoalbuminemia had the highest increase in MACEs (adjusted OR, 6.800; 95% CI, 3.883-11.907; P < 0.001), followed by low-SHR hypoalbuminemia (adjusted OR, 3.033; 95% CI, 1.775-5.182, P < 0.001), and high-SHR normalbuminemia (adjusted OR, 2.375; 95% CI, 1.335-4.226, P = 0.003). High-SHR was associated with increased cardiovascular risk regardless of baseline albumin level for MACEs (normalbuminemia: adjusted OR, 2.325; 95% CI, 1.307-4.136, P = 0.004; hypoalbuminemia: adjusted OR, 2.213; 95% CI, 1.343-3.647, P = 0.002; P = 0.866 for interaction), and cardiac shock or ACHF. Higher SHR is prevalent among patients with AMI, especially in those with hypoalbuminemia. Higher SHR was consistently associated with a more unfavorable in-hospital prognosis, regardless of their baseline albumin value.