Relative Hyperglycemia and In-Hospital Bleeding Across Glycemic Status in Patients on High-Intensity Antithrombotic Therapy

作者：Chong Zhang, Junxiang Liu, Wennan Liu, Hangkuan Liu, Pengfei Sun, Yiwen Fang, Jingbo Yang, Haonan Sun, Yongle Li, Roger Foo, Ching‐Hui Sia, Gregg C. Fonarow, Qing Yang, Yingwu Liu, Xin Zhou, on behalf of the CCC-ACS Investigators · 发表于：Circulation Journal · 年份：2025 · DOI：10.1253/circj.cj-25-0017 · 被引用次数：5 · 研究领域：Hyperglycemia and glycemic control in critically ill and hospitalized patients、Diabetes Management and Research、Diabetes Treatment and Management

BACKGROUND: Relative hyperglycemia, as defined by the stress hyperglycemia ratio (SHR), is linked to death and ischemic events in patients with acute coronary syndrome (ACS). As a modifiable factor, the association between SHR and bleeding risk after percutaneous coronary intervention (PCI) across different glycemic status remains unexplored. METHODS AND RESULTS: In this study, ACS patients treated with PCI were extracted from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) registry and the Tianjin Health and Medical Data Platform (THMDP). SHR was derived from admission fasting blood glucose and hemoglobin A1c. Patients were classified as having diabetes mellitus, pre-diabetes mellitus (Pre-DM), or normal glucose regulation. The primary outcome was in-hospital major bleeding. Among the 33,265 patients in the CCC-ACS cohort, major bleeding was recorded for 437. A high SHR (>1.0) independently predicted major bleeding in the total cohort (adjusted odds ratio [aOR] 1.51; 95% confidence interval [CI] 1.24-1.83), with the highest risk in the Pre-DM group (aOR 1.98; 95% CI 1.34-2.92). These findings were externally validated among 23,423 patients with myocardial infarction in the THMDP cohort. Early guideline-directed medical therapy mitigated the bleeding risk associated with a high SHR. CONCLUSIONS: In this study, a high SHR was an independent risk factor for in-hospital major bleeding after PCI, particularly in patients with Pre-DM. Furth...