HbA1c and clinical outcomes after endovascular treatment in patients with posterior circulation large vessel occlusion: a subgroup analysis of a nationwide registry (BASILAR)

Author:

Yue Feixue1,Wang Zhongxiu1,Pu Jie2,Zhang Min3,Liu Yong4,Han Hongxing5,Liu Wenhua6,Wang Xianjun5,Li Rongzong7,Xue Dongzhang8,Cao Jiaming9,Yan Zhizhong9,Niu Guozhong10,Zhang Hao10,Guan Haitao11,Zeng Hongliang12,You Feng13,Yang Qian14,Zi Wenjie13,Zhang Yi15,Shao Zetao16,Liu Jincheng17,Sun Jun18,Wang Shouchun19ORCID

Affiliation:

1. Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China

2. Department of Neurology, Hubei Province People’s Hospital, Wuhan, China

3. Department of Neurology, Chinese Medical Hospital of Maoming, Maoming, China

4. Department of Neurology, Liu’an Affiliated Hospital of Anhui Medical University, Liu’an, China

5. Department of Neurology, Linyi People’s Hospital, Linyi, China

6. Department of Neurology, Wuhan No. 1 Hospital, Wuhan, China

7. Department of Neurology, The 924th Hospital of The People’s Liberation Army, Guilin, China

8. Department of Neurology, The 902th Hospital of The People’s Liberation Army, Bangfu, China

9. Department of Neurology, The 904th Hospital of The People’s Liberation Army, Wuxi, China

10. Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China

11. Department of Neurology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

12. Department of Neurology, Ganzhou People’s Hospital, Ganzhou, China

13. Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China

14. Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China

15. Department of Neurology, The First People’s Hospital of Chenzhou, Chenzhou, China

16. Department of Neurology, Changle People’s Hospital, Weifang, China

17. Department of Neurology, The First People’s Hospital of Xiangyang, Hubei Medical University, Xiangyang, China

18. Department of Neurology, Nanyang Central Hospital, Nanyang, China

19. Department of Neurology, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun, Jilin 130021, China

Abstract

Background and aims: Recently, several clinical trials have shown that increased glycated hemoglobin (HbA1c) level is correlated with poor clinical outcomes in ischemic stroke patients after thrombolysis and possibly after mechanical thrombectomy. However, the effect of HbA1c on posterior circulation large vessel occlusion (PCLVO) patients treated with endovascular thrombectomy (EVT) remains unclear. This multicenter study assessed the association between the HbA1c levels and clinical outcomes in patients with PCLVO after EVT. Methods: We studied 385 PCLVO ischemic stroke patients included in the EVT for acute basilar artery occlusion study (BASILAR). Patients were divided into a high HbA1c level group (HbA1c >6.5%) and a low HbA1c level group (HbA1c ⩽6.5%). The efficacy outcome was a 90-day favorable functional outcome (modified Rankin Scale 0–3). The safety outcomes included symptomatic intracerebral hemorrhage and mortality at 90 days after EVT. Results: The frequency of a favorable outcome in patients with an HbA1c ⩽6.5% was significantly higher than that in the HbA1c >6.5% group (41.2% versus 26.2%, p = 0.001). In multivariate analysis with adjusted confounders, high HbA1c levels and favorable outcomes were significantly negatively correlated. There was also a significant association between high HbA1c levels and mortality after 3 months. The negative effects of high HbA1c levels on functional status after 3 months were exacerbated in patients aged ⩾65 years. Conclusion: Our multicenter study suggests that a higher serum HbA1c level (HbA1c >6.5%) is an independent predictor of a 90-day poor outcome and mortality in patients with PCLVO after EVT, particularly in those aged ⩾65 years. Clinical Trial Registry identifier: ChiCTR1800014759.

Publisher

SAGE Publications

Subject

Neurology (clinical),Neurology,Pharmacology

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