الفهرس 
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Abstract
Abnormal glucose metabolism is a predictor of worse outcome after acute coronary syndrome (ACS). However, this parameter is not included in risk prediction scores, including GRACE risk score. For more pecification, stress hyperglycemia ratio (SHR) was suggested as a better predictive marker of critical illness (in-hospital death or critical care) in hospitalized patients with any acute illness We sought to evaluate whether the inclusion of blood glucose at admission in a model with GRACE risk score improves risk stratification. The aim of this study was to determine the risk prediction of major adverse cardiac events (MACE) in acute myocardial infarction patients using SHR & correlate the results with GRACE (Global Registry of Acute Coronary Events) SCORE. The study included 100 consecutive patients who admitted with acute myocardial infarction and undergo SHR with study duration for one year. The cases were recruited from Outpatient clinic or internal department of cardiovascular department, Mansoura Specialized Internal Medicine Hospital, Mansoura University, Mansoura, Egypt for duration of 1 year between January 2019 and December 2019. The cases were subjected to full history taking including demographic data, history of the current disease and associated chronic disease. Full clinical examination including general and cardiac examination. Laboratory investigations including measurement of HbA1C & random blood glucose at admission and assessment of serum creatinine. ECG and echocardiography were conducted for all the participants in the study. The cases were followed up till the end of the study period to determine the overall survival and factors associated with survival. The results of this study showed that: The mean age of studied cases was 55.41 ± 10.5 years and there were 83 male (83.0%) and 17 female (17.0%) in the study cases. DM, HTN, smoking, obesity, CKD were the major associated risk factors in the study cases. Streptokinase used in 79 cases and PCI in 38 cases. MACE was happened in 25.0% of cases. The male gender, incidence of smoking and dyslipidemia were significantly higher in the diabetic cases as compared with the non-diabetics. The incidence of MACE was statistically significantly higher in the diabetic patients. GRACE score was significantly elevated in diabetic patients compared to non-diabetics. MACE group was older than without MACE group. history of HTN and dyslipidemia were significantly higher in with MACE group. There was significant increase of HbA1C and RBS in with MACE group compared to without MACE group. There was significant reduction of EF among MACE group compared to without MACE group. GRACE score and SHR were significantly elevated in MACE group compared to without MACE group SHR revealed better diagnostic ability for prediction of MACE in the study cases as compared with GRACE score. Positive history of HTN, GRACE score were significantly risk factor for MACE. According to the best cutoff point obtained in this study, SHR revealed higher accuracy of assessment of DFS as compared with GRACE score.