Limits...
Insulin resistance is associated with a poor response to intravenous thrombolysis in acute ischemic stroke.

Calleja AI, García-Bermejo P, Cortijo E, Bustamante R, Rojo Martínez E, González Sarmiento E, Fernández-Herranz R, Arenillas JF - Diabetes Care (2011)

Bottom Line: The probability of good outcome decreased gradually with increasing HOMA-IR tertiles (80.6%, 1st tertile; 71.4%, 2nd tertile; and 55.3%, upper tertile).A HOMA-IR in the upper tertile was independently associated with poor outcome when compared with the lower tertile (odds ratio [OR] 8.54 [95% CI 1.67-43.55]; P = 0.01) and was associated with more persistent MCA occlusions (OR 8.2 [1.23-54.44]; P = 0.029).High IR may be associated with more persistent arterial occlusions and worse long-term outcome after acute ischemic stroke thrombolysis.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Stroke Unit, Hospital Clínico Universitario de Valladolid, University of Valladolid, Valladolid, Spain. aicsanz@hotmail.com

ABSTRACT

Objective: Insulin resistance (IR) may not only increase stroke risk, but could also contribute to aggravate stroke prognosis. Mainly through a derangement in endogenous fibrinolysis, IR could affect the response to intravenous thrombolysis, currently the only therapy proved to be efficacious for acute ischemic stroke. We hypothesized that high IR is associated with more persistent arterial occlusions and poorer long-term outcome after stroke thrombolysis.

Research design and methods: We performed a prospective, observational, longitudinal study in consecutive acute ischemic stroke patients presenting with middle cerebral artery (MCA) occlusion who received intravenous thrombolysis. Patients with acute hyperglycemia (≥155 mg/dL) receiving insulin were excluded. IR was determined during admission by the homeostatic model assessment index (HOMA-IR). Poor long-term outcome, as defined by a day 90 modified Rankin scale score ≥ 3, was considered the primary outcome variable. Transcranial Duplex-assessed resistance to MCA recanalization and symptomatic hemorrhagic transformation were considered secondary end points.

Results: A total of 109 thrombolysed MCA ischemic stroke patients were included (43.1% women, mean age 71 years). The HOMA-IR was higher in the group of patients with poor outcome (P = 0.02). The probability of good outcome decreased gradually with increasing HOMA-IR tertiles (80.6%, 1st tertile; 71.4%, 2nd tertile; and 55.3%, upper tertile). A HOMA-IR in the upper tertile was independently associated with poor outcome when compared with the lower tertile (odds ratio [OR] 8.54 [95% CI 1.67-43.55]; P = 0.01) and was associated with more persistent MCA occlusions (OR 8.2 [1.23-54.44]; P = 0.029).

Conclusions: High IR may be associated with more persistent arterial occlusions and worse long-term outcome after acute ischemic stroke thrombolysis.

Show MeSH

Related in: MedlinePlus

Relation between IR and long-term clinical outcome. Bars show the probability of achieving good clinical outcome across HOMA-IR tertiles.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3198275&req=5

Figure 1: Relation between IR and long-term clinical outcome. Bars show the probability of achieving good clinical outcome across HOMA-IR tertiles.

Mentions: Three months after stroke onset, six patients had died (mRS-score = 6) and we made a follow-up visit to all remaining patients. Of them 34 (31.2%) had a mRS-score >2. HOMA-IR was higher in the poor outcome group (OR 1.66 [95% CI 1.08–2.73]) than in the group of patients with good outcome (1.29 [0.81–1.88]; P = 0.02). The probability of good clinical outcome decreased gradually with increasing HOMA-IR tertiles (Fig. 1).


Insulin resistance is associated with a poor response to intravenous thrombolysis in acute ischemic stroke.

Calleja AI, García-Bermejo P, Cortijo E, Bustamante R, Rojo Martínez E, González Sarmiento E, Fernández-Herranz R, Arenillas JF - Diabetes Care (2011)

Relation between IR and long-term clinical outcome. Bars show the probability of achieving good clinical outcome across HOMA-IR tertiles.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3198275&req=5

Figure 1: Relation between IR and long-term clinical outcome. Bars show the probability of achieving good clinical outcome across HOMA-IR tertiles.
Mentions: Three months after stroke onset, six patients had died (mRS-score = 6) and we made a follow-up visit to all remaining patients. Of them 34 (31.2%) had a mRS-score >2. HOMA-IR was higher in the poor outcome group (OR 1.66 [95% CI 1.08–2.73]) than in the group of patients with good outcome (1.29 [0.81–1.88]; P = 0.02). The probability of good clinical outcome decreased gradually with increasing HOMA-IR tertiles (Fig. 1).

Bottom Line: The probability of good outcome decreased gradually with increasing HOMA-IR tertiles (80.6%, 1st tertile; 71.4%, 2nd tertile; and 55.3%, upper tertile).A HOMA-IR in the upper tertile was independently associated with poor outcome when compared with the lower tertile (odds ratio [OR] 8.54 [95% CI 1.67-43.55]; P = 0.01) and was associated with more persistent MCA occlusions (OR 8.2 [1.23-54.44]; P = 0.029).High IR may be associated with more persistent arterial occlusions and worse long-term outcome after acute ischemic stroke thrombolysis.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Stroke Unit, Hospital Clínico Universitario de Valladolid, University of Valladolid, Valladolid, Spain. aicsanz@hotmail.com

ABSTRACT

Objective: Insulin resistance (IR) may not only increase stroke risk, but could also contribute to aggravate stroke prognosis. Mainly through a derangement in endogenous fibrinolysis, IR could affect the response to intravenous thrombolysis, currently the only therapy proved to be efficacious for acute ischemic stroke. We hypothesized that high IR is associated with more persistent arterial occlusions and poorer long-term outcome after stroke thrombolysis.

Research design and methods: We performed a prospective, observational, longitudinal study in consecutive acute ischemic stroke patients presenting with middle cerebral artery (MCA) occlusion who received intravenous thrombolysis. Patients with acute hyperglycemia (≥155 mg/dL) receiving insulin were excluded. IR was determined during admission by the homeostatic model assessment index (HOMA-IR). Poor long-term outcome, as defined by a day 90 modified Rankin scale score ≥ 3, was considered the primary outcome variable. Transcranial Duplex-assessed resistance to MCA recanalization and symptomatic hemorrhagic transformation were considered secondary end points.

Results: A total of 109 thrombolysed MCA ischemic stroke patients were included (43.1% women, mean age 71 years). The HOMA-IR was higher in the group of patients with poor outcome (P = 0.02). The probability of good outcome decreased gradually with increasing HOMA-IR tertiles (80.6%, 1st tertile; 71.4%, 2nd tertile; and 55.3%, upper tertile). A HOMA-IR in the upper tertile was independently associated with poor outcome when compared with the lower tertile (odds ratio [OR] 8.54 [95% CI 1.67-43.55]; P = 0.01) and was associated with more persistent MCA occlusions (OR 8.2 [1.23-54.44]; P = 0.029).

Conclusions: High IR may be associated with more persistent arterial occlusions and worse long-term outcome after acute ischemic stroke thrombolysis.

Show MeSH
Related in: MedlinePlus