Background: The purpose of the study is to evaluate whether prestroke glycemic control is associated with functional outcome in patients with acute ischemic stroke after endovascular treatment.
Methods: We reviewed the acute ischemic stroke patients who underwent endovascular recanalization in the participating centers between April 2008 and March 2015 from the Clinical Research Center for Stroke-5th division (CRCS-5) registry. The relationship between the level of HbA1c on admission and functional outcome at 3 month, stroke recurrence and composite outcome (stroke, myocardial infarction, or vascular death) occurrence were assessed.
Results: All 829 study subjects were classified as 4 groups according to quartiles of HbA1c on admission: 1st quartile (HbA1c ≤5.6%), 2nd quartile (5.6% < HbA1c ≤5.9%), 3rd quartile (5.9% < HbA1c ≤6.5%), 4th quartile (HbA1c >6.5%). END occurred more frequently in the highest quartile of HbA1c (P=0.02). Among the components of END, the frequency of symptomatic hemorrhagic transformation occurred more often in the group with higher quartiles (P=0.03), while stroke recurrence or recurrence was not significantly different according to the quartiles of HbA1c (P=0.27). After adjusting for significant variables (age, sex, initial NIHSS, diabetes, complete recanalization, procedure time, occurrence of END, P<0.05), HbA1c on admission >6.5% was still inversely associated with favorable functional outcome at 3 month (adjusted OR 0.48, 95% CI 0.25-0.93 as quartiles, adjusted OR 0.40, 95% CI 0.22-0.73 as a dichotomized variable). No significant heterogeneities were observed according to the age, diagnosis of diabetes on admission, stroke subtype, recanalization degree, and reperfusion time. The cumulative risk of both stroke recurrence and composite even rates were not significantly different according to the quartiles of HbA1c on admission (P=0.64, P=0.19, respectively).
Conclusion: Prestroke glycemic control is associated with occurrence of symptomatic hemorrhagic ransformaion and functional outcome in patients with acute ischemic stroke after endovascular treatment. More stringent glycemic control of HbA1c below or equal to 6.5 % may have beneficial effect on neurological recovery after stroke.