Abstract W P22: Is Hemoglobin A1c (HbA1C) Level an Independent Predictor of Adverse Outcomes in Patients With Acute Ischemic Stroke Undergoing Endovascular Treatment?
Background: There is controversy whether acute or chronic hyperglycemia increases the rate of adverse outcomes in patients undergoing endovascular procedures.
Objective: To evaluate the relationship between hemoglobin A1c (HbA1c), a marker of chronic hyperglycemia, and post-thrombolytic intracerebral hemorrhage (ICH), mortality and independence at discharge.
Methods: Consecutive patients with acute ischemic stroke who underwent emergent endovascular treatment over seven years at three comprehensive stroke centers were included. HbA1c levels were collected within seven days of the procedure and strata was defined as (≤6.0%, 6.1 to 7.0% and >7.1%). Patient characteristics and outcomes were analyzed including age, use of intravenous rt-PA, and use of additional mechanical thrombolysis. The rates of post-thrombolytic ICH and independence at discharge (modified Rankin score (mRS) = 0-2) and inpatient mortality were analyzed after adjusting for potential confounders.
Results: There were 185 patients who received endovascular treatment for acute ischemic stroke; mean ±standard deviation (SD) age was 66.7 ± 15.6, and 82 (44.3%) were women. Rates of post-thrombolytic ICH was higher in patients with higher levels of HbA1c [11.6% in ≤6.0 strata, 15.7% in 6.1-7.0 strata, and 22.6% in ≥7.1 strata]. Rate of independence at discharge was lower in patients with higher levels of HbA1c [36.8% in ≤6.0 strata, 25.5% in 6.1-7.0 strata, and 23.3% in ≥7.1 strata] while inpatient mortality was higher [13.6% in ≤6.0 strata, 15.7% in 6.1-7.0 strata, and 26.7% in ≥7.1 strata]. Adjusting for age, admission NIHSS score, gender, medical comorbidities, recanalization and type of endovascular treatments, the HbA1C strata correlated with an increase in post-thrombolytic ICH (odds ratio [OR], 1.96, 95% confidence interval [CI], 0.94-4.13, p= 0.074). We did not find any relation between increasing HbA1C and independence at discharge or inpatient mortality: (p= 0.6320) and (p= 0.6112), respectively.
Conclusion: Chronic hyperglycemia increases the risk of post-thrombolytic ICH following endovascular treatment in acute ischemic stroke patients through mechanisms not yet clearly understood.
Author Disclosures: S.A. Chaudhry: None. T.T. Zafar: None. A. Saeed: None. M.M. Adil: None. M. Afzal: None. V. Jadhav: None. A.E. Hassan: None. S.I. Hussain: None. A.I. Qureshi: None.
- © 2014 by American Heart Association, Inc.