The Effect of Hyperglycemia on Infarct Growth after Reperfusion : An Analysis of the DEFUSE 3 trial
Copyright © 2020 Elsevier Inc. All rights reserved..
BACKGROUND AND PURPOSE: Brain infarct growth, despite successful reperfusion, decreases the likelihood of good functional outcome after ischemic stroke. In patients undergoing reperfusion, admission glucose is associated with poor outcome but the effect of glucose level on infarct growth is not well studied.
MATERIALS AND METHODS: This is a secondary analysis of the DEFUSE 3 trial. The primary predictor was baseline glucose level and the primary outcome is the change of the ischemic core volume from the baseline to 24-hour follow-up imaging (∆core), transformed as a cube root to reduce right skew. We included DEFUSE 3 patients who were randomized to endovascular therapy, had perfusion imaging data at baseline, an MRI at 24 hours, and who achieved TICI 2b or 3. Linear regression models, both unadjusted and adjusted, were fit to the primary outcome and all models included the baseline core volume as a covariate to normalize ∆core.
RESULTS: We identified 62 patients who met our inclusion criteria. The mean age was 68.1±13.1 (years), 48.4% (30/62) were men, and the median (IQR) cube root of ∆core was 2.8 (2.0-3.8) mL. There was an association between baseline glucose level and normalized ∆core in unadjusted analysis (beta coefficient 0.010, p = 0.01) and after adjusting for potential confounders (beta coefficient 0.008, p = 0.03).
CONCLUSION: In acute ischemic stroke patients with large vessel occlusion undergoing successful endovascular reperfusion, baseline hyperglycemia is associated with infarction growth. Further study is needed to establish potential neuroprotective benefits of aggressive glycemic control prior to and after reperfusion.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:30 |
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| Enthalten in: |
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association - 30(2021), 1 vom: 06. Jan., Seite 105380 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Yaghi, Shadi [VerfasserIn] |
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| Links: |
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| Themen: |
Acute treatment |
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| Anmerkungen: |
Date Completed 04.01.2021 Date Revised 02.01.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jstrokecerebrovasdis.2020.105380 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM317345168 |
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| 100 | 1 | |a Yaghi, Shadi |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The Effect of Hyperglycemia on Infarct Growth after Reperfusion |b An Analysis of the DEFUSE 3 trial |
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| 500 | |a Date Revised 02.01.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND AND PURPOSE: Brain infarct growth, despite successful reperfusion, decreases the likelihood of good functional outcome after ischemic stroke. In patients undergoing reperfusion, admission glucose is associated with poor outcome but the effect of glucose level on infarct growth is not well studied | ||
| 520 | |a MATERIALS AND METHODS: This is a secondary analysis of the DEFUSE 3 trial. The primary predictor was baseline glucose level and the primary outcome is the change of the ischemic core volume from the baseline to 24-hour follow-up imaging (∆core), transformed as a cube root to reduce right skew. We included DEFUSE 3 patients who were randomized to endovascular therapy, had perfusion imaging data at baseline, an MRI at 24 hours, and who achieved TICI 2b or 3. Linear regression models, both unadjusted and adjusted, were fit to the primary outcome and all models included the baseline core volume as a covariate to normalize ∆core | ||
| 520 | |a RESULTS: We identified 62 patients who met our inclusion criteria. The mean age was 68.1±13.1 (years), 48.4% (30/62) were men, and the median (IQR) cube root of ∆core was 2.8 (2.0-3.8) mL. There was an association between baseline glucose level and normalized ∆core in unadjusted analysis (beta coefficient 0.010, p = 0.01) and after adjusting for potential confounders (beta coefficient 0.008, p = 0.03) | ||
| 520 | |a CONCLUSION: In acute ischemic stroke patients with large vessel occlusion undergoing successful endovascular reperfusion, baseline hyperglycemia is associated with infarction growth. Further study is needed to establish potential neuroprotective benefits of aggressive glycemic control prior to and after reperfusion | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Acute treatment | |
| 650 | 4 | |a Hyperglycemia | |
| 650 | 4 | |a Infarct growth | |
| 650 | 4 | |a Outcome | |
| 650 | 4 | |a Thrombectomy | |
| 650 | 7 | |a Biomarkers |2 NLM | |
| 650 | 7 | |a Blood Glucose |2 NLM | |
| 700 | 1 | |a Dehkharghani, Seena |e verfasserin |4 aut | |
| 700 | 1 | |a Raz, Eytan |e verfasserin |4 aut | |
| 700 | 1 | |a Jayaraman, Mahesh |e verfasserin |4 aut | |
| 700 | 1 | |a Tanweer, Omar |e verfasserin |4 aut | |
| 700 | 1 | |a Grory, Brian Mac |e verfasserin |4 aut | |
| 700 | 1 | |a Henninger, Nils |e verfasserin |4 aut | |
| 700 | 1 | |a Lansberg, Maarten G |e verfasserin |4 aut | |
| 700 | 1 | |a Albers, Gregory W |e verfasserin |4 aut | |
| 700 | 1 | |a Havenon, Adam de |e verfasserin |4 aut | |
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