Abstract 3797: Patients with Diabetes and Previous Ischemic Strokes in the National Institute of NINDS trial
Background and Purpose Ischemic stroke is the leading cause of morbidity in the United States. Intravenous recombinant tissue plasminogen activator (rt-PA) given within 4.5 hours from symptom onset has shown to improve outcomes. The ECASS III trial, which helped to extend the time window for thrombolysis, had specific exclusion criteria. One of these exclusions was patients who had a past medical history of both previous diabetes (DM) and an ischemic stroke. This retrospective study aims to evaluate the impact of a previous history of both DM and an ischemic stroke on outcome in patients in the NINDS trial.
Methods A retrospective review was conducted of the NINDS database. Subjects with a previous history of both DM and an ischemic stroke were identified. Baseline characteristics were analyzed for any difference between the two groups. The outcome measures included symptomatic intracerebral hemorrhage (sICH) as defined by NINDS criteria, and 90 day NIHSS, mRS and death. The statistical analysis was performed using a two sample median test and a Fisher’s exact test.
Results: Thirty four individuals were identified with a previous history of DM and ischemic stroke. Fifteen (4.8%) were in the treatment group and 19 (6.1%) were in the placebo group. The median age in those treated with rt-PA was 74.6 years compared to 61.9 years in those who received placebo (p=0.02). The median systolic blood pressure was 178mmHg in the treated group versus 150mmHg in the placebo group (p=0.02). There was no difference between the baseline NIHSS. The rt-PA treated patients had a sICH rate of 6.67% compared to 5.26% in the placebo group (p=0.70). The median NIHSS at 90 days was 5 in the treated group and 3.5 in the placebo group (p=0.26). The median 90 day mRS was 4 in the rt-PA group and 2 in the placebo group (p=0.29). Four (26.7%) of treated patients died compared to 3(15.8%) of patients in the placebo group (p=0.67).
Conclusion: Subjects in the NINDS trial who had the past medical history of both DM and an ischemic stroke were older and had a higher blood pressure in the treatment arm. There was no difference in the sICH rate between both groups. There was no difference in the outcomes of both groups. This study is limited by its retrospective nature and the small sample size of the sub-group.
- © 2012 by American Heart Association, Inc.