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

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...

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Autores principales: Genceviciute, Kotryna, Göldlin, Martina B., Kurmann, Christoph C., Mujanovic, Adnan, Meinel, Thomas R., Kaesmacher, Johannes, Seiffge, David J., Jung, Simon, Mordasini, Pasquale, Fischer, Urs, Gralla, Jan, Sarikaya, Hakan, Goeggel Simonetti, Barbara, Antonenko, Kateryna, Umarova, Roza M., Bally, Lia, Arnold, Marcel, Heldner, Mirjam R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9544025/
https://www.ncbi.nlm.nih.gov/pubmed/35719010
http://dx.doi.org/10.1111/ene.15456
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author Genceviciute, Kotryna
Göldlin, Martina B.
Kurmann, Christoph C.
Mujanovic, Adnan
Meinel, Thomas R.
Kaesmacher, Johannes
Seiffge, David J.
Jung, Simon
Mordasini, Pasquale
Fischer, Urs
Gralla, Jan
Sarikaya, Hakan
Goeggel Simonetti, Barbara
Antonenko, Kateryna
Umarova, Roza M.
Bally, Lia
Arnold, Marcel
Heldner, Mirjam R.
author_facet Genceviciute, Kotryna
Göldlin, Martina B.
Kurmann, Christoph C.
Mujanovic, Adnan
Meinel, Thomas R.
Kaesmacher, Johannes
Seiffge, David J.
Jung, Simon
Mordasini, Pasquale
Fischer, Urs
Gralla, Jan
Sarikaya, Hakan
Goeggel Simonetti, Barbara
Antonenko, Kateryna
Umarova, Roza M.
Bally, Lia
Arnold, Marcel
Heldner, Mirjam R.
author_sort Genceviciute, Kotryna
collection PubMed
description 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%, OR(adjusted) = 0.59, p = 0.004; death: 38.9% vs. 24.1%, OR(adjusted) = 1.75, p = 0.002; mRS shift: p (adjusted) < 0.0001; if moderate/good collaterals and mismatch, mRS = 0–2: OR(adjusted) = 0.52, p = 0.005; death: OR(adjusted) = 1.95, p = 0.005). If analysis was additionally adjusted for AH, only mRS shift was still significantly worse in patients with DM (p (adjusted) = 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%, OR(adjusted) = 0.52, p < 0.0001; death: 40.4% vs. 22.4%, OR(adjusted) = 1.80, p = 0.001; mRS shift: p (adjusted) < 0.0001; if moderate/good collaterals and mismatch, mRS = 0–2: OR(adjusted) = 0.38, p < 0.0001; death: OR(adjusted) = 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: OR(adjusted) = 0.58, p = 0.004; death: OR(adjusted) = 1.57, p = 0.014; mRS shift: p (adjusted) = 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.
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spelling pubmed-95440252022-10-14 Association of diabetes mellitus and admission glucose levels with outcome after endovascular therapy in acute ischaemic stroke in anterior circulation Genceviciute, Kotryna Göldlin, Martina B. Kurmann, Christoph C. Mujanovic, Adnan Meinel, Thomas R. Kaesmacher, Johannes Seiffge, David J. Jung, Simon Mordasini, Pasquale Fischer, Urs Gralla, Jan Sarikaya, Hakan Goeggel Simonetti, Barbara Antonenko, Kateryna Umarova, Roza M. Bally, Lia Arnold, Marcel Heldner, Mirjam R. Eur J Neurol Stroke 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%, OR(adjusted) = 0.59, p = 0.004; death: 38.9% vs. 24.1%, OR(adjusted) = 1.75, p = 0.002; mRS shift: p (adjusted) < 0.0001; if moderate/good collaterals and mismatch, mRS = 0–2: OR(adjusted) = 0.52, p = 0.005; death: OR(adjusted) = 1.95, p = 0.005). If analysis was additionally adjusted for AH, only mRS shift was still significantly worse in patients with DM (p (adjusted) = 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%, OR(adjusted) = 0.52, p < 0.0001; death: 40.4% vs. 22.4%, OR(adjusted) = 1.80, p = 0.001; mRS shift: p (adjusted) < 0.0001; if moderate/good collaterals and mismatch, mRS = 0–2: OR(adjusted) = 0.38, p < 0.0001; death: OR(adjusted) = 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: OR(adjusted) = 0.58, p = 0.004; death: OR(adjusted) = 1.57, p = 0.014; mRS shift: p (adjusted) = 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. John Wiley and Sons Inc. 2022-07-01 2022-10 /pmc/articles/PMC9544025/ /pubmed/35719010 http://dx.doi.org/10.1111/ene.15456 Text en © 2022 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Stroke
Genceviciute, Kotryna
Göldlin, Martina B.
Kurmann, Christoph C.
Mujanovic, Adnan
Meinel, Thomas R.
Kaesmacher, Johannes
Seiffge, David J.
Jung, Simon
Mordasini, Pasquale
Fischer, Urs
Gralla, Jan
Sarikaya, Hakan
Goeggel Simonetti, Barbara
Antonenko, Kateryna
Umarova, Roza M.
Bally, Lia
Arnold, Marcel
Heldner, Mirjam R.
Association of diabetes mellitus and admission glucose levels with outcome after endovascular therapy in acute ischaemic stroke in anterior circulation
title Association of diabetes mellitus and admission glucose levels with outcome after endovascular therapy in acute ischaemic stroke in anterior circulation
title_full Association of diabetes mellitus and admission glucose levels with outcome after endovascular therapy in acute ischaemic stroke in anterior circulation
title_fullStr Association of diabetes mellitus and admission glucose levels with outcome after endovascular therapy in acute ischaemic stroke in anterior circulation
title_full_unstemmed Association of diabetes mellitus and admission glucose levels with outcome after endovascular therapy in acute ischaemic stroke in anterior circulation
title_short Association of diabetes mellitus and admission glucose levels with outcome after endovascular therapy in acute ischaemic stroke in anterior circulation
title_sort association of diabetes mellitus and admission glucose levels with outcome after endovascular therapy in acute ischaemic stroke in anterior circulation
topic Stroke
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9544025/
https://www.ncbi.nlm.nih.gov/pubmed/35719010
http://dx.doi.org/10.1111/ene.15456
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