Stress hyperglycaemic ratio is independently associated with intramyocardial haemorrhage in STEMI patients: a cardiac magnetic resonance study

Abstract

ST-segment elevation myocardial infarction (STEMI) often results in microvascular injury, including intramyocardial haemorrhage (IMH), despite successful reperfusion. This study explored whether the stress hyperglycaemic ratio (SHR) is independently associated with IMH in STEMI patients undergoing primary percutaneous coronary intervention (pPCI). We screened 650 consecutive STEMI patients who underwent pPCI at the Affiliated Hospital of Xuzhou Medical University (2019–2024). After exclusions, 508 patients were included in the final analysis. SHR was calculated as admission glucose (mmol/L) divided by estimated average glucose from HbA1c converted to mmol/L: ([28.7 × HbA1c (%) − 46.7] ÷ 18). IMH was evaluated with cardiac magnetic resonance (CMR) imaging performed within 3–7 days post-pPCI using T2*-mapping sequences. Multivariable logistic regression identified independent predictors of IMH, and Receiver operating characteristic (ROC) analysis assessed the predictive performance of SHR. Higher SHR was independently associated with IMH. Among 508 patients, IMH was present in 179 (35.2%). Patients with IMH had significantly higher SHR (0.87 vs. 0.81, p < 0.001). After adjusting for age, sex, WBC count, and haemoglobin, an elevated SHR remained independently associated with IMH (adjusted OR 1.18; 95% CI 1.07–1.29; p = 0.001). ROC analysis showed an AUC of 0.625 (95% CI 0.577–0.673, p < 0.001), indicating modest predictive ability, with an optimal cutoff of 0.86 (sensitivity 59.2%, specificity 63.8%). SHR is independently associated with IMH in reperfused STEMI patients and may warrant further investigation as a research tool for risk stratification in future studies. These findings support cardiometabolic research in STEMI management strategies.