Objective:

To investigate the impact of stress hyperglycemia (SHG), defined as elevated blood glucose levels due to acute stress, on short- and long-term outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) and evaluate its role in risk stratification.

Key Findings:

• The SHG group had significantly higher in-hospital all-cause mortality (IHACM) at 13.4% compared to 2.19% in the non-SHG group (P < 0.001).
• SHG was identified as the strongest independent risk factor for IHACM (OR = 4.68, 95% CI: 1.98–11.04).
• At one year, the SHG group exhibited higher mortality (14.9% vs. 3.76%) and heart failure incidence (26.0% vs. 12.23%, P < 0.05) compared to the non-SHG group.
• Long-term mortality was primarily associated with Killip classification and coronary artery disease severity.

Interpretation:

SHG is a significant independent risk factor for in-hospital mortality in STEMI patients, suggesting the need for early risk stratification and management of acute glucose fluctuations to improve patient outcomes.

Limitations:

• The study is retrospective and conducted at a single center, which may limit generalizability and external validity.
• Potential confounding factors related to acute hemodynamic instability were not fully explored.

Conclusion:

Incorporating SHG into early risk stratification and developing individualized management strategies for acute-phase glucose fluctuations are recommended to improve outcomes in STEMI patients.