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

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. Further clinical trials are needed to explore SHR-targeted therapies in Pre-DM.