Stress Hyperglycemic Ratio Independently Predicts Intramyocardial Haemorrhage (IMH) in STEMI Patients: A Cardiac Magnetic Resonance (CMR) Study

Background: ST-segment elevation myocardial infarction (STEMI) often results in microvascular injury, including intramyocardial haemorrhage (IMH), despite successful reperfusion. This study explored whether stress hyperglycemic ratio (SHR) independently predicts IMH in STEMI patients undergoing primary percutaneous coronary intervention (pPCI). Methods: We retrospectively analyzed 508 STEMI patients who underwent pPCI at The Affiliated Hospital of Xuzhou Medical University (2019–2024). SHR was calculated as Admission Glucose / (28.7 × HbA1c − 46.7). IMH was evaluated with cardiac magnetic resonance (CMR) imaging performed within 3–7 days post-pPCI using T2-mapping sequences. Multivariate logistic regression was used to identify independent predictors of IMH, and Receiver operating characteristic (ROC) analysis assessed SHR predictive performance. Results: Higher SHR was independently associated with IMH, patients with IMH had significantly higher SHR (0.87 vs 0.81, p < 0.001). After adjusting for age, gender, WBC count and haemoglobin, elevated SHR remained independently associated with IMH (adjusted OR 1.72; 95% CI 1.34–2.21; p < 0.001). ROC analysis showed (AUC = 0.625, 95% CI 0.577–0.673, p < 0.001), indicating modest predictive ability, with an optimal cutoff value of 0.83 (sensitivity of 63.7% and specificity of 58.7%). Conclusions: SHR independently predicts IMH in reperfused STEMI patients and may serve as a simple, readily available biomarker for early risk stratification of microvascular injury. These findings support cardiometabolic workup into STEMI management strategies.