Glucose modifies the effect of endovascular thrombectomy in patients with acute stroke: a pooled-data meta-analysis

Chamorro, A. et al. (2019) Glucose modifies the effect of endovascular thrombectomy in patients with acute stroke: a pooled-data meta-analysis. Stroke, 50(3), pp. 690-696. (doi: 10.1161/STROKEAHA.118.023769) (PMID:30777000)

Abstract

Background and Purpose: Hyperglycemia is a negative prognostic factor following acute ischemic stroke but is not known whether glucose is associated with the effects of endovascular thrombectomy in patients with large vessel stroke. In a pooled-data meta-analysis, we analyzed whether serum glucose is a treatment modifier of the efficacy of endovascular thrombectomy in acute stroke. Methods: Seven randomized trials compared endovascular thrombectomy with standard care between 2010 and 2017 (HERMES Collaboration). 1764 patients with large vessel stroke were allocated to endovascular thrombectomy (n=871) or standard care (n=893). Measurements included blood glucose on admission and functional outcome [modified Rankin Scale (mRS) range: 0-6; lower scores indicating less disability] at 3 months. The primary analysis evaluated whether glucose modified the effect of EVT over standard care on functional outcome, using ordinal logistic regression to test the interaction between treatment and glucose level. Results: Median (IQR) serum glucose on admission was 120 (104-140) mg/dl [6.6mmol/l (5.7-7.7) mmol/l]. Endovascular thrombectomy (EVT) was better than standard care in the overall pooled-data analysis [common odds ratio (acOR), 2.00 (95% CI 1.69–2.38); however, lower glucose levels were associated with greater effects of EVT over standard care. The interaction was nonlinear such that significant interactions were found in subgroups of patients split at glucose < or > 90mg/dl (5.0mmol/l) [(p=0.019 for interaction, acOR 3.81 (95% CI 1.73–8.41) for patients < 90 mg/dl vs 1.83 (95% CI 1.53–2.19) for patients > 90 mg/dl], and glucose < or > 100mg/dl (5.5mmol/l) [(p=0.004 for interaction, acOR 3.17 (95% CI 2.04–4.93) vs acOR 1.72 (95% CI 1.42–2.08)], but not between subgroups above these levels of glucose. Conclusions: Endovascular thrombectomy improved stroke outcomes compared to standard treatment regardless of glucose levels but the treatment effects were larger at lower glucose levels, with significant interaction effects persisting up to 90 to 100mg/dl (5.0-5.5mmol/l). Whether tight control of glucose improves the efficacy of endovascular thrombectomy following large vessel stroke warrants appropriate testing.

• Item Type: Articles
• Additional Information: An unrestricted grant was provided to the University of Calgary by Medtronic who had no role in study design, the data collection, analysis or interpretation of data, the writing of the report or the decision to submit the paper for publication.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Muir, Professor Keith
• Authors: Chamorro, A., Brown, S., Amaro, S., Hill, M. D., Muir, K. W., Dippel, D. W.J., van Zwam, W., Butcher, K., Ford, G. A., den Hertog, H. M., Mitchell, P. J., Demchuck, A. M., Majoie, C. B.L.M., Bracard, S., Sibon, I., Jadhav, A. P., Lara-Rodriguez, B., Aad, v. d. L., Osei, E., Renú, A., Richard, S., Rodriguez-Luna, D., Donnan, G. A., Dixit, A., Almekhlafi, M., Deltour, S., Epstein, J., Guillon, B., Bakchine, S., Gomis, M., du Mesnil de Rochemont, R., Lopes, D., Reddy, V., Rudel, G., Roos, Y. B.W. E.M., Bonafe, A., Diener, H.-C., Berkhemer, O. A., Cloud, G. C., Davis, S. M., van Oostenbrugge, R., Guillemin, F., Goyal, M., Campbell, B. C.V., and Menon, B. K.
• College/School: College of Medical Veterinary and Life Sciences > School of Psychology & Neuroscience
• Journal Name: Stroke
• Publisher: American Heart Association
• ISSN: 0039-2499
• ISSN (Online): 1524-4628
• Published Online: 19 February 2019
• Copyright Holders: Copyright © 2019 American Heart Association, Inc.
• First Published: First published in Stroke 50(3):690-696
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher