Abstract:Aim To explore the predictive value of stress hyperglycemia ratio (SHR) for in-hospital mortality and mechanical complications in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods This study constituted a retrospective investigation that collected 995 patients diagnosed with acute STEMI at Suining Central Hospital from June 2019 to July 2023. Comparisons of baseline data were conducted using t-test, Mann-Whitney U test and chi-square test; Logistic regression was used to analyze the association between SHR and the risk of in-hospital mortality and mechanical complications in acute STEMI patients; Restricted cubic spline analysis based on the Logistic regression model was utilized to explore non-linear relationship between SHR and the risk of in-hospital mortality and mechanical complications; ROC curve was used to evaluate the diagnostic efficacy of SHR; Subgroup analysis was used to assess the predictive efficacy of SHR in each subgroup. Results Patients with high SHR had a significantly higher cardiovascular mortality (P=0.007). High SHR was an independent risk factor for in-hospital all-cause mortality (Model 1:OR=3.5,5%CI:1.719~5.538, P<0.001; Model 2:OR=2.8,5%CI:1.4439~5.132, P=0.002), cardiovascular mortality (Model 1:OR=3.6,5%CI:1.869~6.228, P<0.001; Model 2:OR=3.3,5%CI:1.595~5.817, P<0.001), ventricular aneurysm (Model 1:OR=3.3,5%CI:1.665~6.069, P<0.001; Model 2:OR=3.3,5%CI:1.785~8.663, P<0.001), cardiac rupture (Model 1:OR=2.1,5%CI:1.389~4.312, P=0.002; Model 2:OR=2.2,5%CI:1.214~4.274, P=0.009) and composite endpoint (Model 1:OR=3.9,5%CI:2.226~6.332, P<0.001; Model 2:OR=2.9,5%CI:1.576~5.405, P<0.001) in patients with acute STEMI. SHR was positively correlated in a linear relationship with the risk of in-hospital all-cause mortality (P for non-linearity=0.250), cardiovascular mortality (P for non-linearity=0.129), ventricular aneurysm (P for non-linearity=0.588), cardiac rupture (P for non-linearity=0.787) and composite endpoint (P for non-linearity=0.399). The SHR had excellent diagnostic efficacy for in-hospital all-cause mortality (AUC=0.694), cardiovascular mortality (AUC=0.697), ventricular aneurysm (AUC=0.706) , cardiac rupture (AUC=0.667) and composite endpoint (AUC=0.730), meanwhile SHR predicted efficacy consistently across subgroups. Conclusions High SHR is an independent risk factor for in-hospital all-cause mortality, cardiovascular mortality and cardiac mechanical complications in patients with acute STEMI. SHR holds significant predictive value for the prognosis of patients with STEMI.