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Observational Study
. 2022 Oct;29(10):2996-3008.
doi: 10.1111/ene.15456. Epub 2022 Jul 1.

Association of diabetes mellitus and admission glucose levels with outcome after endovascular therapy in acute ischaemic stroke in anterior circulation

Kotryna Genceviciute  1 , Martina B Göldlin  1   2 , Christoph C Kurmann  2 , Adnan Mujanovic  2 , Thomas R Meinel  1 , Johannes Kaesmacher  2 , David J Seiffge  1 , Simon Jung  1 , Pasquale Mordasini  2 , Urs Fischer  1   3 , Jan Gralla  2 , Hakan Sarikaya  1 , Barbara Goeggel Simonetti  1 , Kateryna Antonenko  1   4 , Roza M Umarova  1 , Lia Bally  5 , Marcel Arnold  1 , Mirjam R Heldner  1
Affiliations
Observational Study

Association of diabetes mellitus and admission glucose levels with outcome after endovascular therapy in acute ischaemic stroke in anterior circulation

Kotryna Genceviciute et al. Eur J Neurol. 2022 Oct.

Abstract

Background and purpose: We aimed to assess the association of diabetes mellitus (DM) and admission hyperglycaemia (AH), respectively, and outcome in patients with acute ischaemic stroke with large vessel occlusion in the anterior circulation treated with endovascular therapy (EVT) in daily clinical practice.

Methods: Consecutive EVT patients admitted to our stroke centre between February 2015 and April 2020 were included in this observational cohort study. Patients with versus without DM and with versus without AH (glucose ≥ 7.8 mmol/L) were compared.

Results: We included 1020 patients (48.9% women, median age = 73.1 years); 282 (27.6%) had DM, and 226 (22.2%) had AH. Patients with versus without DM less often showed successful reperfusion (odds ratio [OR]adjusted = 0.61, p = 0.023) and worse 3-month functional outcome (modified Rankin Scale [mRS] = 0-2: 31.3% vs. 48%, ORadjusted = 0.59, p = 0.004; death: 38.9% vs. 24.1%, ORadjusted = 1.75, p = 0.002; mRS shift: padjusted < 0.0001; if moderate/good collaterals and mismatch, mRS = 0-2: ORadjusted = 0.52, p = 0.005; death: ORadjusted = 1.95, p = 0.005). If analysis was additionally adjusted for AH, only mRS shift was still significantly worse in patients with DM (padjusted = 0.012). Patients with versus without AH showed similar successful reperfusion rates and worse 3-month functional outcome (mRS = 0-2: 28.3% vs. 50.4%, ORadjusted = 0.52, p < 0.0001; death: 40.4% vs. 22.4%, ORadjusted = 1.80, p = 0.001; mRS shift: padjusted < 0.0001; if moderate/good collaterals and mismatch, mRS = 0-2: ORadjusted = 0.38, p < 0.0001; death: ORadjusted = 2.39, p < 0.0001). If analysis was additionally adjusted for DM, 3-month functional outcome remained significantly worse in patients with AH (mRS = 0-2: ORadjusted = 0.58, p = 0.004; death: ORadjusted = 1.57, p = 0.014; mRS shift: padjusted = 0.004). DM independently predicted recurrent/progressive in-hospital ischaemic stroke (OR = 1.71, p = 0.043) together with admission National Institutes of Health Stroke Scale score (OR = 0.95, p = 0.005), and AH independently predicted in-hospital symptomatic intracranial haemorrhage (OR = 2.21, p = 0.001). The association of admission continuous glucose levels and most outcome variables was (inversely) J-shaped.

Conclusions: Hyperglycaemia more than DM was associated with worse 3-month outcome in the patients studied, more likely so in the case of moderate/good collaterals and mismatch in admission imaging.

Keywords: acute ischaemic stroke; admission glucose levels; diabetes mellitus; endovascular therapy; outcome.

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Conflict of interest statement

M.B.G. reports grants from the Swiss Academy of Medical Sciences/Bangerter‐Rhyner Foundation, Swiss Stroke Society, and Mittelbauvereinigung der Universität Bern as well as congress support from Pfizer. T.R.M. reports research support from the Bangerter Rhyner Foundation, Swiss National Science Foundation, and Swiss Heart Foundation. J.K. reports research support from the Swiss Academy of Medical Sciences, Bangerter Rhyner Foundation, Swiss Stroke Society, and Clinical Trials Unit Bern. P.M. reports research support from Siemens, Cerenovus, iSchemaview, Medtronic, and Stryker and is has received honoraria and consultation fees from Medtronic, Cerenovus, Phenox, and Microvention, paid to the institution. U.F. reports research support from Medtronic, Stryker, and CSL Behring. J.G. is a global principal investigator of STAR, Clinical Event Committee member of the PROMISE study, and principal investigator and consultant for the SWIFT DIRECT study and receives Swiss National Science Foundation grants for magnetic resonance imaging in stroke. K.A. reports research support from the Swiss National Science Foundation. M.A. reports personal fees from Bayer, Bristol‐Myers Squibb, Medtronic, Amgen, Daiichi Sankyo, Nestlé Health Sciences, Boehringer Ingelheim, and Covidien. M.R.H. reports research support from the Bangerter Rhyner Foundation, SITEM Research Funds, Swiss Heart Foundation, and Swiss National Science Foundation and Amgen advisory board participation in 2020. No author reports any disclosures directly related to this article. None of the other authors has any conflict of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Flow chart of patients who met inclusion and exclusion criteria
FIGURE 2
FIGURE 2
Probability of outcome by continuous admission glucose levels for all patients. sICH, symptomatic intracranial haemorrhage [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 3
FIGURE 3
Probability of outcome by continuous admission glucose levels for patients with moderate or good collaterals and small core or target mismatch in admission imaging [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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