Association of glycemic gap with stroke recurrence in patients with ischemic stroke.

BACKGROUND: Glycemic gap, as a novel index of acute glycemic excursion, is associated with poor prognosis of different diseases. This study aimed to explore the association of the glycemic gap with long-term stroke recurrence in patients with ischemic stroke. METHODS: This study included patients with ischemic stroke from the Nanjing Stroke Registry Program. The glycemic gap was calculated by subtracting the estimated average blood glucose from the blood glucose at admission. Multivariable Cox proportional hazards regression analysis was performed to explore the association between the glycemic gap and the risk of stroke recurrence. The Bayesian hierarchical logistic regression model was used to estimate the effects of the glycemic gap on stroke recurrence stratified by diabetes mellitus and atrial fibrillation. RESULTS: Among 2734 enrolled patients, 381 (13.9%) patients experienced stroke recurrence during a median follow-up of 3.02 years. In multivariate analysis, glycemic gap (high group vs. median group) was associated with significantly increased risk for stroke recurrence (adjusted hazard ratio, 1.488; 95% confidence interval, 1.140-1.942; p = .003) and had varying effects on stroke recurrence depending on atrial fibrillation. The restricted cubic spline curve showed a U-shaped relationship between the glycemic gap and stroke recurrence (p = .046 for nonlinearity). CONCLUSION: Our study found that the glycemic gap was significantly associated with stroke recurrence in patients with ischemic stroke. The glycemic gap was consistently associated with stroke recurrence across subgroups and had varying effects depending on atrial fibrillation.

Aggressive medical care in young chinese patients with ischemic stroke of undetermined etiology: a retrospective study.

OBJECTIVES: This study aimed to investigate the clinical and angiographic characteristics of ischemic stroke of undetermined etiology in young Chinese adults and to observe the effects of medication on their long-term outcomes. METHODS: A total of 179 consecutive young patients with ischemic stroke of undetermined etiology were retrospectively analyzed for clinical and angiographic characteristics, laboratory tests, the choice of drug treatment, and follow-up outcomes. Any predictive power for recurrent stroke and new lesions or aggravated stenosis was analyzed. RESULTS: 170 patients were clinically followed up for a median of 25 months (range, 4-92), and 65 patients with 114 lesions had angiographic follow-up for a median of 7 months. A total of 53 patients were enrolled in a routine medical management (RMM) group, and 117 were treated with corticosteroids plus RMM (aggressive medical management, AMM). Kaplan-Meier survival analysis revealed that differences in the 2-year cumulative stroke-free rate and in the 18-month cumulative worsening and/or new lesion-free rate between the RMM and AMM groups were significant (p < 0.05). Multivariate and Cox regression analyses revealed that the choice of drug therapy and erythrocyte sedimentation rate were associated with recurrent stroke, that AMM was independently associated with a decreased risk of worsening lesion, and that worsening lesion was the only independent predictor of recurrent stroke. CONCLUSION: Compared with RMM, AMM is more efficacious in the prevention of secondary ischemic stroke and progressive arterial lesions among young adults with ischemic stroke of undetermined etiology.