Cardiovasc Diabetol. 2026 Feb 14. doi: 10.1186/s12933-026-03100-8. Online ahead of print.
ABSTRACT
BACKGROUND: The stress hyperglycemia ratio (SHR), calculated as the ratio of admission blood glucose to estimated average glucose derived from glycated hemoglobin, quantifies the degree of relative hyperglycemia during acute physiological stress. This systematic review and meta-analysis aimed to synthesize the current evidence on the association between SHR and the anatomical severity and clinical prognosis of coronary artery disease (CAD).
METHODS: PubMed, EMBASE, Web of Science, and the Cochrane Library were systematically searched for studies published from inception to January 24, 2026. Cross-sectional, retrospective, and prospective cohort studies involving patients with CAD were included. Outcomes related to CAD severity comprised large thrombus burden, multi-vessel disease, non-target lesion progression, and in-stent restenosis. The primary outcome for CAD prognosis was major adverse cardiovascular events (MACE). Data were pooled using random-effects models to estimate hazard ratios (HRs) or odds ratios (ORs) and their 95% confidence intervals (CIs). CAD is classified into acute coronary syndrome (ACS) and chronic coronary syndrome (CCS).
RESULTS: Nine studies evaluating CAD severity and thirty-one studies assessing CAD prognosis met the inclusion criteria. SHR was significantly associated with multiple markers of increased CAD severity. In the ACS subgroup, pooled analysis indicated that the highest SHR levels were significantly associated with an increased risk of MACE (HR: 1.60, 95% CI 1.41-1.81, P < 0.00001; OR: 1.58, 95% CI 1.19-2.11, P = 0.002). This prognostic value was confirmed in continuous variable analyses (HR: 1.59, 95% CI 1.27-2.00; OR: 3.50, 95% CI 1.47-8.32 per unit increment). Similarly, in the CCS subgroup, patients in the highest SHR category exhibited a higher risk of MACE (HR: 1.95, 95% CI 1.50-2.52; P < 0.00001), a finding consistent across continuous analyses (HR: 1.87, 95% CI 1.64-2.12, P < 0.00001 per unit increment). Consistently significant associations were observed across various secondary endpoints and additional subgroups.
CONCLUSION: The current evidence suggests that SHR can reflect the anatomical complexity of CAD patients and serves as a valuable, easily accessible tool for risk stratification in this population.
PMID:41688977 | DOI:10.1186/s12933-026-03100-8