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

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.