The present systematic review and meta-analysis aimed to investigate the prognostic value of stress hyperglycemia ratio (SHR) in patients with acute myocardial infarction (AMI). A total of 26 cohort studies, involving 87974 patients, were analyzed. The frequentist meta-analysis showed that AMI patients with SHR in the upper quantile had a significantly higher hazard of major adverse cardiovascular and cerebrovascular events (MACCE, HR = 1.7; 95% CI= [1.42, 2.03]; P< 0.001; I²= 71%; P <0.01), long-term (HR = 1.64; 95% CI= [1.49, 1.8]; P< 0.001; I²= 16%; P= 0.29) and in-hospital all-cause mortality (OR = 3.87; 95% CI= [2.98, 5.03]; P< 0.001; I²= 54%; P= 0.03) compared to those with lower SHR. Prespecified subgroup analyses revealed that these results were consistent irrespective of diabetes status (P= 0.32 and 0.73 for subgroup differences) and that SHR was a significant predictor of MACCE both in AMI with obstructive coronary arteries (HR = 1.57; 95% CI= [1.34, 1.83]; P< 0.001; I²= 66%; P< 0.01) and MINOCA (HR = 2.57; 95% CI= [1.86, 3.56]; P< 0.001; I²= 0%; P= 0.84). The Bayesian analyses with weakly prior assumptions yielded comparable results with the frequentist approach and provided strong evidence that higher SHR values were associated with significantly greater hazard of MACCE, short-term and long-term mortality. Further, prospective research is warranted to provide deeper insights into this newer index of stress hyperglycemia before its potential incorporation in clinical prediction scores.

本系统评价和荟萃分析旨在探讨应激性高血糖比（SHR）对急性心肌梗死（AMI）患者的预后价值。总共分析了 26 项队列研究，涉及 87974 名患者。频率学荟萃分析显示，SHR处于上分位数的AMI患者发生主要不良心脑血管事件的风险显着较高（MACCE，HR=1.7；95%CI=[1.42，2.03]；P<0.001；I ² = 71%；P <0.01）、长期（HR = 1.64；95% CI= [1.49, 1.8]；P< 0.001；I ² = 16%；P= 0.29）和院内全因死亡率（与 SHR 较低的患者相比，OR = 3.87；95% CI= [2.98, 5.03]；P< 0.001；I ^{2 = 54%；P= 0.03）。}预先指定的亚组分析显示，无论糖尿病状况如何，这些结果都是一致的（亚组差异 P = 0.32 和 0.73），并且 SHR 是伴有冠状动脉阻塞的 AMI 中 MACCE 的显着预测因子（HR = 1.57；95% CI = [1.34] ，1.83]；P < 0.001；I ² = 66%；P < 0.01）和 MINOCA（HR = 2.57；95% CI= [1.86，3.56]；P < 0.001；I ² = 0%；P = 0.84）。使用弱先验假设进行的贝叶斯分析得出了与频率论方法相当的结果，并提供了强有力的证据，表明较高的 SHR 值与显着更大的 MACCE、短期和长期死亡率风险相关。此外，在将其潜在纳入临床预测评分之前，有必要进行前瞻性研究，以更深入地了解这一新的应激性高血糖指数。