Stress hyperglycemia ratio in coronary artery disease: a systematic review and meta-analysis of severity and prognosis
Authors' conclusion
The current evidence suggests that SHR can reflect the anatomical complexity of CAD patients and serves as a valuable, easily accessible tool for risk stratification in this population.
Study context
- Population
- Patients with coronary artery disease (CAD) (acute coronary syndrome (ACS) and chronic coronary syndrome (CCS)); Stress hyperglycemia ratio (SHR) = admission blood glucose / estimated average glucose from HbA1c; databases searched to January 24, 20269 severity, 31 prognosis studies
- Comparison
- Highest vs lower SHR levels; SHR per unit increment
- Outcome
- Major adverse cardiovascular events (MACE) (CAD prognosis)
Methodological detailsrandom-effects models, cross-sectional, retrospective and prospective cohort studies
- Random-effects models
- Cross-sectional, retrospective and prospective cohort studies
Pooled result
As reported in the abstract
MACE, ACS and CCS subgroups
Highest SHR vs Lower SHREstimate (95% CI)P value
ACS subgroup
HR 1.60(1.41–1.81)
P < 0.00001ACS subgroup
OR 1.58(1.19–2.11)
P = 0.002CCS subgroup
HR 1.95(1.50–2.52)
P < 0.00001- ACS, SHR as continuous variable: HR per unit increment
- 1.59 (95% CI 1.27-2.00)
- ACS, SHR as continuous variable: OR per unit increment
- 3.50 (95% CI 1.47-8.32)
- CCS, SHR as continuous variable: HR per unit increment
- 1.87 (95% CI 1.64-2.12), P < 0.00001
Further pooled results
CAD severity (large thrombus burden, multi-vessel disease, non-target lesion progression, in-stent restenosis)
- SHR was significantly associated with multiple markers of increased CAD severity
Secondary endpoints and additional subgroups
- Consistently significant associations across various secondary endpoints and additional subgroups
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Stress hyperglycemia ratio in coronary artery disease: a systematic review and meta-analysis of severity and prognosis. Cardiovasc Diabetol. Published 14 February 2026. doi:10.
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