Predictive Value Of The Stress Hyperglycemia Ratio On Contrast Induced Nephropathy After PPCI In Patients With Acute STEMI

Objective:To investigate the relationship between stress hyperglycemia ratio(SHR)and contrast media nephropathy(CIN))after primary percutaneous coronary intervention(PPCI)in patients with acute ST-segment elevation myocardial infarction(STEIMI).Metdods:A total of 439 patients with acute STEMI who received PPCI in The Second Affiliated Hospital of Guangzhou Medical University from June 2018 to June 2020 were collected.According to the history of diabetes,patients were divided into non-diabetic group(n=319 cases)and diabetic group(n=120cases).The SHR of the two groups were calculated by formula calculation,then the patients in the two groups were divided into low SHR group and high SHR group according to the median of SHR(1.147 in non-diabetic group and 1.279 in diabetic group).According to the occurrence of CIN,they were divided into non-CIN group and CIN group.The basic clinical data,laboratory examination results and coronary intervention results of the patients were collected by consulting the medical record system and the chest pain center website.The SPSS 22 statistical software was used for statistical analysis to compare the clinical data between low SHR group and high SHR group of non-diabetic and diabetic patients with AMI.Univariate Logistic regression analysis was used to analyze the related risk factors of CIN and the predictive role of SHR in all patients and subgroups of patients.Multivariate Logistic regression analysis was used to further analyze the independent risk factors.The receiver operating characteristic(ROC)curve was used to compare the predictive value of admission blood glucose and SHR in predicting the occurrence of CIN after PCI in patients with STEMI.Results:1.Non-diabetic patients1.1 There were 20 cases(12.5%)of CIN in low SHR group and 41 cases(25.8%)of CIN in high SHR group.There were significant differences in admission blood glucose,stress hyperglycemia(SHG),fasting blood glucose,Hb A1 c,admission creatinine(Scr),admission GFR,white blood cells,left ventricular ejection fraction(LVEF)and in-hospital use of diuretics between the two groups(P<0.05).There were significant differences between non-CIN group and CIN group in stroke history,admission blood glucose,SHG,SHR,fasting blood glucose,uric acid,admission Scr,preoperative GFR,LVEF,length of operation and in-hospital use of diuretics(P < 0.05).1.2 There were more MACE in hospital in high SHR group(P < 0.05),and there was significant difference in MACE between non-CIN group and CIN group(P < 0.05).The results of univariate and multivariate Logistic regression analysis showed that SHR(OR=5.143,95% CI=2.067-12.799,P < 0.001)and admission blood glucose(OR=1.343,95% CI=1.154-1.563,P < 0.001)were independent risk factors for CIN in non-diabetic patients.1.3 The results of ROC curve analysis showed that the AUC of SHR for predicting the occurrence of CIN after PPCI in non-diabetic patients was 0.657(95%CI=0.602-0.709,P < 0.001),suggesting that it has a certain predictive value for the occurrence of CIN after PPCI in non-diabetic patients,and the predictive cutoff value is 1.036.Using Medcalc software to further compare the ROC curve of SHR and admission blood glucose on the occurrence of CIN in non-diabetic patients after PPCI,the results showed that there was no significant difference in the predictive value between them(P = 0.795),that is,the predictive value of the two was basically the same.2.Diabetic patients2.1 There were 9 cases(15.0%)of CIN in low SHR group and 25 cases(41.7%)of CIN in high SHR group.In addition,there were significant differences in admission blood glucose,SHG,SHR,Hb A1 c,admission heart rate,uric acid,white blood cells,Killip grade ≥ grade Ⅱ and LVEF between the two groups(P < 0.05);There were significant differences in fasting blood glucose,Hb A1 c,SHR,D-dimer,uric acid,LVEF and operation duration between non-CIN group and CIN group(P <0.05).2.2 There were more in-hospital MACE in the high SHR group(P < 0.05).At the same time,there was a statistically significant difference in hospital MACE events between the non-CIN group and the CIN group(P < 0.05).The results of univariate and multivariate Logistic regression analysis showed that high SHR was an independent risk factor for CIN(OR=6.479,95%CI=1.506-27.867),while admission blood glucose was not an independent risk factor for CIN.2.3 The results of ROC curve analysis showed that the AUC of SHR for predicting the occurrence of CIN after PPCI in diabetic patients was 0.714(95%CI=0.624-0.793 P < 0.001),suggesting that SHR has a certain predictive value for the occurrence of CIN after PPCI in diabetic patients,and its predictive cutoff value is 1.191.Medcalc software was used to further compare the ROC curve of SHR and admission blood glucose on the occurrence of CIN in diabetic patients after PPCI.The results showed that the predictive value of SHR was better than that of admission blood glucose(P =0.001).3.All patients and subgroups of patientsUnivariate Logistic regression analysis showed that SHR was a good predictor of CIN in all patients and subgroups according to sex,age > 75 years,diabetes,hyperuricemia,LVEF < 50%,GFR < 60ml/min/1.73m2 and dyslipidemia(P <0.005).Conclusion:Regardless of whether there is a diabetes,SHR is an independent risk factor that occurs after PPCI in patients with acute Stemi.In diabetic patients,its predicted value is higher than that of admission blood sugar,may be a new indicator of CIN after PPCI.