DOI: 10.1161/jaha.124.034556 ISSN: 2047-9980

Detrimental Effect of Acute Hyperglycemia on the Outcomes of Large Ischemic Region Stroke

Kanta Tanaka, Takeshi Yoshimoto, Junpei Koge, Hiroshi Yamagami, Hirotoshi Imamura, Nobuyuki Sakai, Kazutaka Uchida, Mikiya Beppu, Yuji Matsumaru, Yasushi Matsumoto, Kazumi Kimura, Reiichi Ishikura, Manabu Inoue, Fumihiro Sakakibara, Takeshi Morimoto, Shinichi Yoshimura, Kazunori Toyoda,
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Background

Although endovascular therapy (EVT) is effective for large ischemic region strokes, the impact of hyperglycemia remains unclear.

Methods and Results

We analyzed data from the RESCUE‐Japan LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra‐Acute Embolism‐Japan Large Ischemic Core) trial, which randomized stroke patients with Alberta Stroke Program Early Computed Tomography Score of 3 to 5 to EVT versus medical management. Outcomes were compared among patients with normoglycemia (<140 mg/dL), moderate hyperglycemia (≥140, <180 mg/dL), and severe hyperglycemia (≥180 mg/dL) on admission. Among 200 patients (median age 76.5 years, median glucose level 131 mg/dL, EVT 50%), diabetes prevalence was 10.0%, 18.4%, and 71.0% in the groups with normoglycemia (n=120), moderate hyperglycemia (n=49), and severe hyperglycemia (n=31), respectively. Achievement of modified Rankin Scale score 0 to 3 at 90 days was less frequent in the group with severe hyperglycemia (6.5%) than in the groups with normoglycemia (25.0%) and moderate hyperglycemia (24.5%), with adjusted odds ratios (aOR) of 1.48 (95% CI, 0.59–3.72) for moderate and 0.17 (95% CI, 0.03–0.95) for severe hyperglycemia relative to normoglycemia. The risk of symptomatic intracranial hemorrhage was higher for moderate hyperglycemia (6.1%; aOR, 2.86 [95% CI, 0.42–19.71]) and particularly for severe hyperglycemia (25.8%; aOR, 18.59 [95% CI, 2.47–139.87]) compared with normoglycemia (2.5%). Symptomatic intracranial hemorrhage rates were similar for EVT and medical management in normoglycemia (1.6% versus 3.4%) and moderate hyperglycemia (5.0% versus 6.9%), but for severe hyperglycemia, the rate was higher in patients with EVT (36.8%) than in those without (8.3%).

Conclusions

Severe hyperglycemia was associated with worse functional prognosis and increased symptomatic intracranial hemorrhage in large ischemic region strokes.

Registration

URL:  https://clinicaltrials.gov . Identifier: NCT03702413.

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