Background
The metabolic syndrome (MetS) is common in patients with acute ischemic stroke (IS);
however, its impact on outcome after intravenous thrombolysis (iv-thrombolysis) remains
unclear. Thus, we aimed at evaluating the relationship between MetS and functional
long-term outcome, mortality, and the presence of hemorrhagic complications in patients
with IS treated with iv-thrombolysis.
Methods
We retrospectively evaluated the demographic and clinical data of 535 Caucasian patients
with acute IS who were consecutively treated with iv-thrombolysis from September 2006
to June 2013 in 2 experienced stroke centers in Poland. A favorable functional long-term
outcome was defined as a modified Rankin scale score less than or equal to 2 points
on day 90, and hemorrhagic complications were assessed with European Cooperative Acute
Stroke Study criteria.
Results
MetS was recognized in 192 (35.9%) patients (44.8% men; mean age, 70.8 ± 11.1 years),
diabetes in 29.7%, dyslipidemia in 79.2%, and arterial hypertension in 75.5%. At 3 months,
favorable outcome was found in 55.3% of patients, symptomatic intracerebral hemorrhage
(SICH) in 18.3%, and 4.4 % of patients died. There was no difference regarding the
presence of favorable outcome between patients with and without MetS (52.6% versus
56.9%, P = .34). The presence of SICH and 3-month mortality were more frequent in patients
with MetS than without MetS (6.8% versus 2.9%, P = .03 and 23.4% versus 15.5%, P = .02, respectively); however, a multivariate analysis showed no impact of MetS on
mortality or SICH.
Conclusions
Results of our study provide no data to suggest that the effect of intravenous tissue-type
plasminogen activator differs based on the presence or absence of MetS.
Key Words
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References
- Increasing prevalence of the metabolic syndrome among US adults.Diabetes Care. 2004; 27: 2444-2449
- The incidence and persistence of the NCEP (National Cholesterol Education Program) metabolic syndrome. The French D.E.S.I.R. study.Diabetes Metab. 2003; 29: 526-532
- Epidemiology of metabolic syndrome in Poland. The results of “WOBASZ” study.Kardiol Pol. 2005; 63: 1-4
- Metabolic syndrome and the risk of new vascular events and all-cause mortality in patients with coronary artery disease, cerebrovascular disease, peripheral arterial disease or abdominal aortic aneurysm.Eur Heart J. 2008; 29: 213-223
- The metabolic syndrome is associated with advanced vascular damage in patients with coronary heart disease, stroke, peripheral arterial disease or abdominal aortic aneurysm.Eur Heart J. 2004; 25: 342-348
- Carotid atherosclerosis and coronary heart disease in the metabolic syndrome: prospective data from the Bruneck study.Diabetes Care. 2003; 26: 1251-1257
- Insulin resistant young subjects at risk of accelerated atherosclerosis exhibit a marked reduction in peripheral endothelial function early in life but not differences in intima-media thickness.Atherosclerosis. 2003; 171: 303-309
- Metabolic syndrome and its components as risk factors for first-ever acute ischemic noncardioembolic stroke.J Stroke Cerebrovasc Dis. 2009; 18: 173-177
- Relationship of metabolic syndrome and fibrinolytic dysfunction to cardiovascular disease.Circulation. 2003; 108: 420-425
- Association between metabolic syndrome and functional outcome in patients with acute ischaemic stroke.Eur J Neurol. 2014; 21: 177-179
- Relation between the metabolic syndrome and ischemic stroke or transient ischemic attack: a prospective cohort study in patients with atherosclerotic cardiovascular disease.Stroke. 2005; 36: 1366-1371
- Association between metabolic syndrome and risk of stroke: a meta-analysis of cohort studies.Cerebrovasc Dis. 2008; 25: 539-547
- Impact of metabolic syndrome on coronary patency after thrombolytic therapy for acute myocardial infarction.Coron Artery Dis. 2009; 20: 387-391
- Impact of metabolic syndrome on various aspects of microcirculation and major adverse cardiac events in patients with ST-segment elevation myocardial infarction.Circ J. 2012; 76: 1972-1979
- Metabolic syndrome and resistance to IV thrombolysis in middle cerebral artery ischemic stroke.Neurology. 2008; 71: 190-195
- The metabolic syndrome is associated with a higher resistance to intravenous thrombolysis for acute ischemic stroke in women than in men.Stroke. 2009; 40: 344-349
- Insulin resistance is associated with a poor response to intravenous thrombolysis in acute ischemic stroke.Diabetes Care. 2011; 34: 2413-2417
- Eligibility of stroke units in Poland for administration of intravenous thrombolysis.Eur J Neurol. 2006; 13: 220-224
- Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists.Circulation. 2007; 115: e478-e534
- Guidelines for management of ischaemic stroke and transient ischaemic attack 2008.Cerebrovasc Dis. 2008; 25: 457-507
- Improved reliability of the NIH Stroke Scale using video training. NINDS TPA Stroke Study Group.Stroke. 1994; 25: 2220-2226
- Thrombolysis with alteplase 3 to 4.5 hours after acute ischaemic stroke.N Engl J Med. 2008; 359: 1317-1329
- Thrombolysis with alteplase 3-4.5 h after acute ischaemic stroke (SITS-ISTR): an observational study.Lancet. 2008; 372: 1303-1309
- Expansion of the time window for treatment of acute ischemic stroke with intravenous tissue plasminogen activator: a science advisory from the American Heart Association/American Stroke Association.Stroke. 2009; 40: 2945-2948
- Recovery of motor function after stroke.Stroke. 1988; 19: 1497-1500
- Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators.Lancet. 1998; 352: 1245-1251
- Diagnosis and management of the metabolic syndrome. An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement American Heart Association.Circulation. 2005; 112: 2735-2752
Article info
Publication history
Published online: May 07, 2015
Accepted:
April 1,
2015
Received in revised form:
March 30,
2015
Received:
October 4,
2014
Footnotes
P.S. contributed to the study design, patient selection, clinical work, data collection, analysis, interpretation, and writing of the manuscript. W.B. contributed to the study design, patient selection, clinical work, data collection, analysis, and interpretation. W.S. contributed to patient selection, clinical work, data collection, statistical analysis, and interpretation. M.F. contributed to patient selection, clinical work, data collection, analysis, and interpretation; G.K. contributed to data analysis, interpretation, and the rewriting of the manuscript.
No potential conflict of interests relevant to this article were reported.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.04.001
Copyright
© 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.
