Prognostic significance of stress hyperglycemia ratio in coronary microvascular dysfunction among chronic coronary syndrome patients.

Aims: Coronary microvascular dysfunction (CMD) is a crucial prognostic indicator in chronic coronary syndrome (CCS) patients. The stress hyperglycemia ratio (SHR), a novel biomarker of acute hyperglycemia, has demonstrated predictive value for adverse outcomes in various diseases. However, its association with CMD remains unclear. This study aims to evaluate the prognostic role of SHR in predicting CMD outcomes in CCS patients. Methods: CCS patients who underwent coronary angiography (CAG) were included. Microvascular function was assessed using coronary angiography-derived index of microcirculatory resistance (caIMR), with CMD defined as caIMR > 25U. Patients were divided into three groups based on SHR values: T1 (SHR < 0.73), T2 (SHR 0.73-0.80), and T3 (SHR≥0.80). The primary endpoint was major adverse cardiac events (MACE). Results: 379 CCS patients were included, among which 196 were identified with CMD. The CMD group exhibited higher SHR levels. During a mean follow-up of 32.9 months, 53 MACE events occurred in CMD patients, with a higher incidence in the T3 group compared to the T1/T2 groups (37.681% vs. 16.667% vs. 26.230%, Conclusions: Elevated SHR is associated with adverse outcomes and predicts MACE in CMD patients with CCS. These results highlight the potential of SHR as a valuable tool for early risk stratification and prevention in CMD management. Trial Registration: ClinicalTrials.gov, NCT06698432 (Registration Date: November 19, 2024).