Fasting hyperglycemia on the next day following mechanical thrombectomy (MT) for acute ischemic stroke is associated with worse outcomes at 3-months, according to study results published in the Journal of Stroke and Cerebrovascular Disease.
Higher glucose levels on admission for patients with acute ischemic stroke who underwent MT were previously found to be associated with worse long-term outcome. However, as limited data are available on the importance of fasting glucose levels after MT, the goal of the current study was to explore the association between fasting glucose level on the next day after MT and outcomes and whether diabetes was related to this interaction.
The retrospective analysis of prospectively collected data included patients with acute anterior circulation ischemic stroke admitted to 2 comprehensive stroke centers in Poland and underwent MT between January 2013 and June 2017. Glucose levels were measured on admission and on the next day after MT and overnight fasting. Normal glucose was defined as 3.5-5.5 mmol/L. Hyperglycemia on admission and fasting hyperglycemia were defined as glucose above 7.8 and 5.5 mmol/L, respectively.
The primary outcome was unfavorable 3-month neurological outcome, defined as modified Rankin scale (mRS) score of 3-6 at day 90 from stroke onset.
The study cohort included 181 patients, including 139 patients without diabetes and 42 patients with diabetes. Unfavorable outcomes at 3-month follow-up were reported in almost half of patients, as 85 patients (47.5%) had mRS of 3-6.
While glucose levels on admission and the etiology of stroke were not found to be predictors of unfavorable 3-month neurological outcome, fasting glucose (odds ratio [OR] 1.46; 95% CI, 1.19-1.79, P <.001), age (OR 1.06; 95% CI, 1.02-1.10, P =.001), successful reperfusion (OR 0.09; 95% CI, 0.04-0.22, P <.001), and baseline National Institutes of Health Stroke Scale (NIHSS) (OR 1.18; 95% CI, 1.08-1.29, P <.001) were independent predictors of the primary outcome.
Patients with fasting hyperglycemia had higher mRS at 3-month follow-up compared to those without fasting hyperglycemia (3.71±2.56 vs 1.87±2.22, P <.001).
Among patients with diabetes there was a trend towards worse mRS (3-6) at day 90 from stroke (59.5% vs 43.5%, P =.07). Fasting glucose and glucose on admission were not associated with the risk for unfavorable neurological outcomes at 3-months. The independent predictors of the primary outcome included age (OR 1.28; 95% CI, 1.01-1.27, P =.044), successful recanalization (OR 0.04; 95% CI, 0.01-0.73, P =.030), and NIHSS score on admission (OR 1.40; 95% CI, 1.03-1.90, P =.030).
Among patients without diabetes, fasting hyperglycemia on the next day after MT was evident in 43 patients (23.8%), while 96 patients (53.0%) had normal fasting glucose. The neurological outcomes were worse in those with fasting hyperglycemia (mRS, 3.74±2.52 vs 1.81±3.74, P <.001). The independent predictors of the primary outcome included age (OR 1.05; 95% CI 1.01-1.08, P =.008), fasting glucose (OR 1.57; 95% CI 1.17 -2.11, P =.002), successful reperfusion (OR 0.11; 95% CI 0.04-0.30, P <.001) and baseline NIHSS (OR 1.14; 95% CI 1.04-1.26, P =.011). In this group fasting glucose increased the absolute risk of unfavorable 3-month outcome by 26.5%.
The study had several important limitations, according to the researchers, including the limited sample size, single measurement of glucose levels within the first 24 hours after MT, and lack of assessment of the influence of hypoglycemic agents used.
“The role of glucose levels after MT should be evaluated in future studies which may contribute to ascertain optimal hyperglycemia management during and after this procedure,” concluded the researchers.
Wnuk M, Popiela T, Drabik L, et al. Fasting hyperglycemia and long-term outcome in patients with acute ischemic stroke treated with mechanical thrombectomy [published online ahead of print, 2020 Mar 19]. J Stroke Cerebrovasc Dis. doi:10.1016/j.jstrokecerebrovasdis.2020.104774