Stress Hyperglycemia and Prognosis of Minor Ischemic Stroke and Transient Ischemic Attack: The CHANCE Study (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events).

Abstract

BACKGROUND AND PURPOSE:

We aimed to determine the association between stress hyperglycemia and risk of new stroke in patients with a minor ischemic stroke or transient ischemic attack.

METHODS:

A subgroup of 3026 consecutive patients from 73 prespecified sites of the CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events) were analyzed. Stress hyperglycemia was measured by glucose/glycated albumin (GA) ratio. Glucose/GA ratio was calculated by fasting plasma glucose divided by GA and categorized into 4 even groups according to the quartiles. The primary outcome was a new stroke (ischemic or hemorrhagic) at 90 days. We assessed the association between glucose/GA ratio and risk of stroke by multivariable Cox regression models adjusted for potential covariates.

RESULTS:

Among 3026 patients included, a total of 299 (9.9%) new stroke occurred at 3 months. Compared with patients with the lowest quartile, patients with the highest quartile of glucose/GA ratio was associated with an increased risk of stroke at 3 months after adjusted for potential covariates (12.0% versus 9.2%; adjusted hazard ratio, 1.46; 95% confidence interval, 1.06-2.01). Similar results were observed after further adjusted for fasting plasma glucose. We also observed that higher level of glucose/GA ratio was associated with an increased risk of stroke with a threshold of 0.29 using a Cox regression model with restricted cubic spline.

CONCLUSIONS:

Stress hyperglycemia, measured by glucose/GA ratio, was associated with an increased risk of stroke in patients with a minor ischemic stroke or transient ischemic attack.

CLINICAL TRIAL REGISTRATION:

URL: http://www.clinicaltrials.gov. Unique identifier: NCT00979589.

• Authors: Yuesong Pan, Xueli Cai, Jing Jing, Xia Meng, Hao Li, Yongjun Wang, Xingquan Zhao, Liping Liu, David Wang, S Claiborne Johnston, Tiemin Wei, Yilong Wang, CHANCE Investigators
• Journal: Stroke (Stroke) Vol. 48 Issue 11 Pg. 3006-3011 (11 2017) ISSN: 1524-4628 [Electronic] United States
• PMID: 29051218 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: © 2017 American Heart Association, Inc.

Chemical References

• Blood Glucose
• Glycation End Products, Advanced
• Serum Albumin
• Clopidogrel
• Ticlopidine
• Glycated Serum Albumin

Topics

• Acute Disease
• Adult
• Aged
• Aged, 80 and over
• Blood Glucose (metabolism)
• Brain Ischemia (blood, diagnosis, epidemiology, etiology)
• Clopidogrel
• Double-Blind Method
• Female
• Glycation End Products, Advanced
• Humans
• Hyperglycemia (blood, complications, diagnosis, epidemiology)
• Male
• Middle Aged
• Risk Factors
• Serum Albumin (metabolism)
• Stroke (blood, diagnosis, epidemiology, etiology)
• Ticlopidine (administration & dosage, analogs & derivatives)
• Glycated Serum Albumin