Serum glucose may help identify those admitted for stroke at greatest risk for recurrence
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Presence of hyperglycemia at hospital admission for stroke was linked with elevated risk for subsequent stroke by 90 days, an increase that dual antiplatelet therapy seemingly failed to curtail, researchers reported.
According to research published in the Journal of the American Heart Association, serum glucose measurement may represent a quick and easy assay to identify patients hospitalized for transient ischemic attack or minor ischemic stroke who are at particularly high risk for subsequent stroke.
“The risk of subsequent stroke is as high as 17% in the 90 days following the index event, but this risk is front-loaded within the first 7 days. For this reason, there is a need to incorporate dynamic physiological metrics into risk stratification schemes, and not simply long-term risk factors,” Brian Mac Grory, MB BCh BAO, MRCP, assistant professor of neurology at Duke University School of Medicine, and colleagues wrote. “Serum glucose is an intriguing potential predictor of recurrent stroke risk, because it is already assessed in the majority of patients with acute stroke using widely available, low-cost assays.”
Researchers conducted a secondary analysis of the POINT trial to assess the relationship between hyperglycemia ( 180 mg/dL) compared with normoglycemia (< 180 mg/dL) and 90-day outcomes following stroke hospitalization. Researchers also evaluated the effects of DAPT in this population. The primary endpoint was subsequent ischemic stroke.
POINT was a randomized controlled trial that assessed the effects of aspirin plus clopidogrel compared with aspirin alone for prevention of recurrent stroke among patients with TIA or minor ischemic stroke.
As Healio previously reported, although DAPT may lower risk for recurrent stroke compared with aspirin alone, it may increase risk for major hemorrhagic bleeding.
Impact of hyperglycemia on secondary stroke risk
Among the 4,878 participants in the POINT study, by 90 days, 267 experienced recurrent stroke, with a cumulative incidence of 9.7% in patients with hyperglycemia and 5.2% in those normoglycemic (log-rank P < .001).
After adjusting for age, sex, race, ethnicity, treatment assignment, index event classification and vascular risk factors as covariates, researchers observed significant association between hyperglycemia at hospital admission for TIA or minor ischemic stroke and risk for subsequent stroke compared with normoglycemia (HR = 1.5; 95% CI, 1.05-2.14; P = .01).
According to the study, hyperglycemia at stroke admission was also tied to a composite of ischemic stroke, MI or vascular death compared with normoglycemia (HR = 1.55; 95% CI, 1.1-2.2; P = .01).
In a similarly adjusted model, researchers found no association between hyperglycemia and major hemorrhage compared with normoglycemia (HR = 0.47; 95% CI, 0.11-1.99; P = .31).
DAPT in hyperglycemia following stroke
Researchers reported no risk reduction for subsequent stroke with DAPT initiation in patients with hyperglycemia (HR = 1.18; 95% CI, 0.69-2.03), but found there was lower risk in patients with normoglycemia (HR = 0.63; 95% CI, 0.48-0.83; P for interaction = .04).
“The benefits of clopidogrel/aspirin were not apparent in the small subgroup of patients with hyperglycemia, with an interaction observed between clopidogrel and serum glucose on subsequent stroke,” the researchers wrote.
In a sensitivity analysis that incorporated serum glucose as a continuous variable, researchers saw evidence of a nonlinear relationship between serum glucose and risk for subsequent stroke (P < .001).
“Serum glucose may be a useful measure for identifying patients at high risk of early recurrence. By contrast, assay of glycosylated hemoglobin is reflective only of glycemic control over a period of approximately 2.5 months,” the researchers wrote. “Additionally, measurement of serum glucose can be performed rapidly, is inexpensive and does not require calculation. For this reason, its use is proposed in two scoring systems for predicting hemorrhage after intravenous tissue plasminogen activator use (the TAG and SEDAN scores).”
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