Abnormal glucose metabolism is associated with increasedrisk of cardiovascular adverse outcomes and progression of coronary arterydisease in patients with coronary heart disease. Due to the heterogeneity ofelderly patients, they are more prone to abnormal glucose metabolism, and theiracute response to stress is different from that of young patients.Stresshyperglycemia is a physiological response of the body to trauma, stroke, ACS,etc. in acute stress, characterized by transient hyperglycemia, which has beenproven to be associated with adverse cardiovascular outcomes and increasedhospital mortality.The stress hyperglycemia ratio (SHR) is calculated based onthe absolute levels of glucose and HbAlc, and accurately reflects thebackground glucose level. It has been proven to have good predictive value inpatients with acute myocardial infarction, heart failure, etc. in criticalconditions.Moreover, some studies have shown that SHR is a predictor of theseverity of coronary artery lesions, but its predictive value in elderlypatients is not yet clear.

To investigate the relationship betweenstresshyperglycemia ratio and severity of coronary artery disease in patientswithcoronary artery disease aged 80 years and above.829 CADpatients aged 80 years and above whohospitalized in Beijing Hospital andunderwent PCI from January 1, 2015, toDecember 31, 2021 were included. We recorded thepatients’ clinical data, includingcoronary angiography results, laboratory testresults and echocardiographydata. According to the CAG results, patients weredivided into single-vesseland multi-vessel lesions groups; according to thetertile of stresshyperglycemia ratio, they were divided into 3 groups (T1group, SHR < 0.867;T2 group, 0.867 ≤ SHR < 1.115; and T3 group, SHR ≥1.115), and thecorrelation between SHR and the severity of coronary disease wasanalyzed bylogistic regression analysis. The receiver operating characteristic (ROC) andthe areaunder the curve (AUC) were used to determine the sensitivity andspecificity ofSHR in predicting CAD severity.

Atotal of 486 patients were finally included, with a median age of 82 (81, 84)years, 286 (58.8%) male and 200 (41.2%) female. The SHR was higher in themultivessel disease group than in the univessel disease group. After dividingthe patients into three groups according to the SHR tertile, the proportion ofpatients with multivessel disease in the T3 group (91.9%) was higher than thatin the other two groups (P < 0.05). Logistic regression analysis showed thatwhen SHR was used as a continuous variable, after adjusting for confoundingfactors, SHR was an independent risk factor for multivessel disease (OR =3.718, 95% CI 1.319-10.479, P = 0.0013). When SHR was used as a categoricalvariable, after adjusting for confounding factors, the risk of developingmultivessel disease in the T3 group was 2.106 times that in the T1 group (95%CI 1.020-4.334, P = 0.043). After dividing the patients into groups accordingto their glucose metabolic status, there was a significant association betweenSHR and the risk of multivessel disease in the diabetes group, but nosignificant association in the non-diabetes group (P for interaction = 0.003).Furthermore, the area under the receiver operating characteristic curve (AUC)for predicting coronary multivessel disease using SHR was 0.606 (95% CI0.536-0.676). The restricted cubic spline curve analysis showed a lineardose-response relationship between SHR and multivessel disease (P overall =0.042, P nonlinear = 0.865).

SHR was significantly correlatedwith the risk of multi-vessel lesions and predicted CAD severity in patientswith coronary artery disease aged 80 years and above, especially in DMpatients. Monitoring SHR in this population is important for assessing thecondition, predicting the risk of cardiovascular events, and improving theprognosis.