London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 819 894 Meta-analysis and reviews Diabetes, admission glucose, and outcomes after stroke thrombolysis. A registry and systemat-ic review. J.P. Desilles1, E. Meseguer2, J. Labreuche3, B. Lapergue4, G. Sirimarco5, J. Valcarcel6, P.C. La-vallée7, L. Cabrejo8, C. Guidoux9, I.F. Klein10, P. Amarenco11, M. Mazighi12 Bichat University Hospital, PARIS, FRANCE1, Bichat University Hospital, Paris, FRANCE2, Bichat University Hospital, Paris, FRANCE3, Bichat University Hospital, Paris, FRANCE4, Bichat University Hospital, Paris, FRANCE5, Bichat University Hospital, Paris, FRANCE6, Bichat Uni-versity Hospital, Paris, FRANCE7, Bichat University Hospital, Paris, FRANCE8, Bichat University Hospital, Paris, FRANCE9,Bichat University Hospital, Paris, FRANCE10, Bichat University Hospi-tal, Paris, FRANCE11, Bichat University Hospital, Paris, FRANCE12 Background: The potential detrimental effect of diabetes and admission glucose level (AGL) on outcomes after stroke thrombolysis is unclear. We evaluated outcomes of patients treated by intrave-nous (IV) and/or intra-arterial (IA) therapy, according to diabetes and AGL. Methods: We analyzed data from a patient registry (n=704) and conducted a systematic review of previous observational studies. The primary study outcome was the percentage of patients who achieved a favorable out-come (modified Rankin score ≤2 at 3 months). Results: We identified 54 previous reports that evalu-ated the effect of diabetes and/or AGL on outcomes after thrombolysis. In unadjusted meta-analysis including our registry data and previous available observational data, diabetes was associated with less favorable outcome (odds ratio OR, 0.76; 95% confidence interval CI, 0.73-0.79) and more symptomatic intracranial hemorrhage (sICH) (OR, 1.38; 95%CI, 1.21-1.56). However, in multivari-able analysis, diabetes remained associated with less favorable outcome (OR, 0.77; 95%CI, 0.69- 0.87) but not with sICH (OR, 1.11; 95%CI, 0.83-1.48). In unadjusted and in adjusted meta-analysis, higher AGL was associated with less favourable outcome and more sICH; the adjusted OR (95%CI) per 1 mmol/L increase in AGL was 0.92 (0.90-0.94) for favorable outcome, and 1.09 (1.04-1.14) for sICH. Conclusions: These results confirm that diabetes and AGL impact clinical prognosis after thrombolysis. AGL is probably a surrogate marker of brain infarction severity rather than a causal factor. 895 Meta-analysis and reviews Therapeutic hypothermia delivery in acute ischaemic stroke: A systematic review and me-ta- analysis of physical methods. L. Kamini1, N. Sprigg2, P.M.W. Bath3 University of Nottingham, Nottingham, UNITED KINGDOM1, University of Nottingham, Uni-versity of Nottingham, UNITED KINGDOM2, University of Nottingham, Nottingham, UNITED KINGDOM3 Introduction Therapeutic hypothermia (TH) is the most promising neuroprotective intervention identified to date. In animal studies, cooling to 35°C reduced infarct size by about one third. Cool-ing awake patients with ischaemic stroke to 35°C has been shown to be feasible. A number of ran-domised control trials have investigated the efficacy, safety and feasibility of TH; this study aims to collate the results of these. Methods We identified published trial data for the systematic review by performing electronic searches of MEDLINE, EMBASE and CENTRAL (1985 to October 2012). Trials were of physical methods of hypothermia delivery. The primary outcome was death or dependency; secondary outcomes includ-ed mortality, safety measures such as serious adverse events (SAE) and efficacy measures such as impairment. These outcomes were dichotomous, analysed using random-effects models and hetero-geneity was assessed. Results No phase III trials were identified: five small trials were identified (n=266). Four of these trials in-cluded awake patients. TH was administered by surface (n=63) or endovascular (n=53) methods. It was not possible to assess death and dependency or efficacy due to differing outcome measures between trials. TH was associated with a non-significant increase in death (OR 1.59, 95% CI 0.81- 3.09) and no heterogeneity was present (I2=0%). Similarly, TH was associated with an increase in SAEs, including pneumonia (OR 3.77, 95% CI 1.06-13.38). A trend to increase in symptomatic in-tracerebral haemorrhage (OR 1.82, 95%CI 0.28-12.07) was seen across 3 studies. Conclusion Larger trials of a higher statistical power are required to adequately determine the safety and effica-cy of TH. The use of common outcome measures will facilitate meta-analysis of trial results.
Karger_ESC London_2013
To see the actual publication please follow the link above