Admission hyperglycemia, stroke subtypes, outcomes in acute ischemic stroke

Area of Science:

• Neurology
• Endocrinology
• Cardiovascular Medicine

Background:

• Admission hyperglycemia is a common complication in acute ischemic stroke (AIS).
• The relationship between hyperglycemia and early vascular outcomes in AIS may vary by stroke subtype.
• Understanding these differences is crucial for personalized treatment strategies.

Purpose of the Study:

• To investigate the differential association of admission hyperglycemia with early vascular outcomes in AIS based on stroke subtype.
• To assess the interaction between hyperglycemia severity and stroke subtypes (large artery atherothrombosis, cardioembolism, small vessel occlusion) on vascular events.

Main Methods:

• A multicenter, prospective stroke registry of 32,772 AIS patients.
• Patients were grouped by admission glucose levels: normoglycemia, moderate hyperglycemia, and severe hyperglycemia.
• Multivariate analysis examined interactions between hyperglycemia and stroke subtypes for 3-month stroke, mortality, and composite outcomes.

Main Results:

• Significant interactions were found between hyperglycemia and stroke subtypes for 3-month stroke and composite outcomes (P<0.005).
• Hyperglycemia was associated with the highest risk of recurrent stroke in cardioembolism (CE) and large artery atherothrombosis (LAA) subtypes.
• The association was least pronounced in small vessel occlusion (SVO) stroke.

Conclusions:

• Admission hyperglycemia is differentially associated with 3-month stroke risk across ischemic stroke subtypes.
• The risk is greatest in CE and LAA subtypes, but not significantly in SVO.
• These findings suggest that glucose-lowering treatment efficacy post-AIS may be subtype-dependent.