Glycated hemoglobin (HbA1c) and outcome following endovascular thrombectomy for ischemic stroke.
Aged
Aged, 80 and over
Biomarkers
/ blood
Brain Ischemia
/ blood
Endovascular Procedures
/ adverse effects
Female
Glycated Hemoglobin
/ metabolism
Humans
Male
Middle Aged
Outcome Assessment, Health Care
Prospective Studies
Registries
Retrospective Studies
Stroke
/ blood
Thrombectomy
/ adverse effects
Treatment Outcome
hemorrhage
stroke
thrombectomy
Journal
Journal of neurointerventional surgery
ISSN: 1759-8486
Titre abrégé: J Neurointerv Surg
Pays: England
ID NLM: 101517079
Informations de publication
Date de publication:
Jan 2020
Jan 2020
Historique:
received:
15
04
2019
revised:
06
05
2019
accepted:
13
05
2019
pubmed:
31
5
2019
medline:
18
3
2020
entrez:
1
6
2019
Statut:
ppublish
Résumé
In ischemic stroke, increased glycated hemoglobin (HbA1c) and glucose levels are associated with worse outcome following thrombolysis, and possibly, endovascular thrombectomy. To evaluate the association between admission HbA1c and glucose levels and outcome following endovascular thrombectomy. Consecutive patients treated with endovascular thrombectomy with admission HbA1c and glucose levels were included. The primary outcome was functional independence, defined as a modified Rankin Scale score of 0-2 at 3 months. Secondary outcomes included successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b-3), early neurological improvement (reduction in National Institutes of Health Stroke Scale (NIHSS) score ≥8 points, or NIHSS score of 0-1 at 24 hours), symptomatic intracerebral hemorrhage (sICH), and mortality at 3 months. 223 patients (136 (61%) men; mean±SD age 64.5±14.6) were included. The median (IQR) HbA1c and glucose were 39 (36-45) mmol/mol and 6.9 (5.8-8.4) mmol/L, respectively. Multiple logistic regression analysis demonstrated that increasing HbA1c levels (per 10 mmol/mol) were associated with reduced functional independence (OR=0.76; 95% CI 0.60-0.96; p=0.02), increased sICH (OR=1.33; 95% CI 1.03 to 1.71; p=0.03), and increased mortality (OR=1.26; 95% CI 1.01 to 1.57; p=0.04). There were no significant associations between glucose levels and outcome measures (all p>0.05). HbA1c levels are an independent predictor of worse outcome following endovascular thrombectomy. The addition of HbA1c to decision-support tools for endovascular thrombectomy should be evaluated in future studies.
Sections du résumé
BACKGROUND
BACKGROUND
In ischemic stroke, increased glycated hemoglobin (HbA1c) and glucose levels are associated with worse outcome following thrombolysis, and possibly, endovascular thrombectomy.
OBJECTIVE
OBJECTIVE
To evaluate the association between admission HbA1c and glucose levels and outcome following endovascular thrombectomy.
METHODS
METHODS
Consecutive patients treated with endovascular thrombectomy with admission HbA1c and glucose levels were included. The primary outcome was functional independence, defined as a modified Rankin Scale score of 0-2 at 3 months. Secondary outcomes included successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b-3), early neurological improvement (reduction in National Institutes of Health Stroke Scale (NIHSS) score ≥8 points, or NIHSS score of 0-1 at 24 hours), symptomatic intracerebral hemorrhage (sICH), and mortality at 3 months.
RESULTS
RESULTS
223 patients (136 (61%) men; mean±SD age 64.5±14.6) were included. The median (IQR) HbA1c and glucose were 39 (36-45) mmol/mol and 6.9 (5.8-8.4) mmol/L, respectively. Multiple logistic regression analysis demonstrated that increasing HbA1c levels (per 10 mmol/mol) were associated with reduced functional independence (OR=0.76; 95% CI 0.60-0.96; p=0.02), increased sICH (OR=1.33; 95% CI 1.03 to 1.71; p=0.03), and increased mortality (OR=1.26; 95% CI 1.01 to 1.57; p=0.04). There were no significant associations between glucose levels and outcome measures (all p>0.05).
CONCLUSIONS
CONCLUSIONS
HbA1c levels are an independent predictor of worse outcome following endovascular thrombectomy. The addition of HbA1c to decision-support tools for endovascular thrombectomy should be evaluated in future studies.
Identifiants
pubmed: 31147437
pii: neurintsurg-2019-015023
doi: 10.1136/neurintsurg-2019-015023
doi:
Substances chimiques
Biomarkers
0
Glycated Hemoglobin A
0
hemoglobin A1c protein, human
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
30-32Informations de copyright
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.