Abstract 73: Resistance to Iv Thrombolysis and Prognostic Impact of Metabolic Syndrome in Middle Cerebral Artery Ischemic Stroke
Background: Metabolic Syndrome (MetS) may confer higher resistance to early arterial recanalization after intravenous (IV) thrombolysis and a poor impact in other prognostic variables after stroke. We aimed to test this hypothesis evaluating not only the clinical syndrome but also some relevant biomarkers associated with MetS and insulin resistance.
Methods: Prospective, observational study in consecutive stroke patients with MCA occlusion and who received IV tPA in a single tertiary-care center. MetS was diagnosed following the unified criteria of the last Joint Interim Statement 2009. We measured PAI-1, adiponectin and CRP levels at admission (before treatment). Primary outcome variable was resistance to thrombolysis defined as the absence of complete MCA recanalization at 2 hours after tPA infusion assessed by transcranial color-coded duplex or when rescue mechanical thrombectomy after IV tPA was needed. Secondary outcome variables were dramatic neurological improvement (decrease in ≥10 points in the NIHSS score in the first 24 hours), poor outcome (mRS score >2 at 3 months), symptomatic intracerebral hemorrhage (SICH) following ECASS II criteria and infarct volume (AXBXC/2).
Results: A total of 234 patients (55.6% men, mean age 69.5±13.3 years, median baseline NIHSS 16 [10-20]) were included and 146 (62.4%) fulfilled MetS criteria. After multivariate analysis MetS was an independent predictor of resistance to thrombolysis (OR 2.2 [1.3-4.2] p=0.01) and absence of early neurological recovery (OR 0.5 [0.28-0.97] p=0.04). In addition, MetS conferred poorer functional outcome at three months, higher SICH rate and increased infarct volume although these associations disappeared after adjustment for covariates. Adiponectin levels in women and CRP and PAI-1 levels in the whole sample were significantly associated with MetS but we found no influence of those biomarkers in resistance to thrombolysis, SICH, infarct volume or early neurological improvement. However, CRP levels were higher in patients with poor functional outcome.
Conclusions: MetS is an independent predictor of resistance to clot dissolution after tPA administration in patients with acute MCA occlusions and it is associated with poorer neurologic outcome.
Author Disclosures: L. Dorado: None. J.F. Arenillas: None. E. López-Cancio: None. M. Hernández-Pérez: None. N. Pérez de la Ossa: None. M. Gomis: None. M. Millán: None. A. Galán: None. A. Dávalos: None.
- © 2014 by American Heart Association, Inc.