Abstract

Objective: This study evaluated the relationship between HbA1c (glycated hemoglobin), admission serum glucose levels and outcomes in patients with large artery occlusion (LAO) treated with mechanical thrombectomy (MT).

Methods: A total of 413 patients were enrolled, and the following outcomes were reviewed: successful recanalization, symptomatic hemorrhage, favorable outcome (modified Rankin Scale, mRS scores of 0-2), and mortality at 3 months. Receiver operating characteristic (ROC) curve analysis was undertaken to identify the cutoff values for HbA1C and glucose to discriminate between favorable and unfavorable outcomes. The association of HbA1c and glucose levels with outcomes was evaluated using logistic regression.

Results: The best cutoff values to discriminate between favorable and unfavorable outcome after 3 months were identified by an HbA1C value of 6.0% and an admission serum glucose level of 131 mg/dL (P = <0.001 and <0.001, respectively). Patients with HbA1C ≥6.0% had a lower ratio of favorable mRS, more symptomatic hemorrhage, and higher mortality than those of HbA1C <6.0% (P = 0.002, 0.001, and <0.001, respectively). In multivariate analysis, high HbA1C (≥6.0%) and serum glucose on admission (≥131 mg/dL) were significantly associated with unfavorable outcomes at 3 months (P = 0.006 and 0.009, respectively).

Conclusion: This study demonstrated that patients with HbA1C ≥6.0% had more unfavorable 3- month mRS, higher symptomatic hemorrhage, and a higher degree of mortality than those with HbA1C <6.0%. Higher HbA1C and admission serum glucose levels are independent predictors of unfavorable clinical outcomes in LAO patients treated with MT.

Keywords: Glucose, glycated hemoglobin, hyperglycemia, ischemic stroke, thrombectomy thrombolysis, mitochondrial dysfunction.