# The role of stress hyperglycemia in in-hospital new-onset atrial fibrillation among patients with acute myocardial infarction: a narrative review

## TL;DR

This paper reviews how stress-induced high blood sugar in heart attack patients increases the risk of new-onset atrial fibrillation and suggests future research directions.

## Contribution

The paper provides a narrative review consolidating evidence and mechanisms linking stress hyperglycemia to new-onset atrial fibrillation in acute myocardial infarction patients.

## Key findings

- Stress hyperglycemia and its ratio are significant predictors of adverse outcomes in AMI patients.
- SHG promotes NOAF through mechanisms like inflammation, oxidative stress, and autonomic remodeling.
- Future research should focus on standardizing SHG criteria and developing predictive models.

## Abstract

Stress hyperglycemia (SHG) is frequently observed in patients with acute myocardial infarction (AMI). Substantial evidence has established both SHG and the stress hyperglycemia ratio (SHR) as significant, independent predictors of adverse outcomes, linking them to an increased risk of major adverse cardiovascular events and demonstrating a strong association with in-hospital new-onset atrial fibrillation (NOAF). This review consolidates epidemiological evidence linking SHG to these clinical endpoints and details the key underlying pathophysiological mechanisms by which SHG promotes NOAF, including inflammatory activation, oxidative stress activation, calcium handling dysfunction, and autonomic remodeling. Future research should prioritize standardizing diagnostic criteria for SHG, developing integrated dynamic prediction models that incorporate SHG/SHR for NOAF risk, and conducting targeted clinical trials to evaluate early interventions.