We evaluated the association between admission glycated hemoglobin (HbA1c) and subsequent risk of composite vascular events, including stroke, myocardial infarction (MI), and vascular death, in patients with acute ischemic stroke and diabetes.

Patients who had a TIA or an acute ischemic stroke within 7 days of symptom onset and diabetes were included in a retrospective cohort design using the stroke registry of the Clinical Research Center for Stroke in Korea. The association between admission HbA1c and composite vascular events, including stroke, MI, and vascular death, during 1-year follow-up was estimated using the Fine-Gray model. The risk of composite vascular events according to the ischemic stroke subtype was explored using fractional polynomial and linear-quadratic models.

Of the 18,567 patients, 1,437 developed composite vascular events during follow-up. In multivariable analysis using HbA1c as a categorical variable, the risk significantly increased at a threshold of 6.8%–7.0%. The influence of admission HbA1c level on the risk of composite vascular events was pronounced particularly among those in whom fasting glucose at admission was ≤130 mg/dL. The optimal ranges of HbA1c associated with minimal risks for composite vascular events were lowest for the small vessel occlusion subtype (6.6 [95% confidence internal [CI], 6.3–6.9]) compared to the large artery atherosclerosis (7.3 [95% CI, 6.8–7.9]) or the cardioembolic subtype (7.4 [95% CI, 6.3–8.5]).

In patients with ischemic stroke and diabetes, the risks of composite vascular events were significantly associated with admission HbA1c. The optimal range of admission HbA1c was below 6.8%–7.0% and differed according to the ischemic stroke subtype.

我们评估了急性缺血性卒中和糖尿病患者入院糖化血红蛋白 (HbA1c) 与随后复合血管事件风险之间的关联，包括卒中、心肌梗死 (MI) 和血管性死亡。

使用韩国中风临床研究中心的中风登记处，将在症状出现后 7 天内患有 TIA 或急性缺血性中风和糖尿病的患者纳入回顾性队列设计。使用 Fine-Gray 模型估计 1 年随访期间入院 HbA1c 与复合血管事件（包括中风、MI 和血管死亡）之间的关联。使用分数多项式和线性二次模型探讨了根据缺血性卒中亚型的复合血管事件风险。

在 18,567 名患者中，1,437 名在随访期间发生了复合血管事件。在使用 HbA1c 作为分类变量的多变量分析中，风险显着增加，阈值为 6.8%–7.0%。入院 HbA1c 水平对复合血管事件风险的影响尤为明显，尤其是在入院时空腹血糖≤130 mg/dL 的患者中。与大动脉粥样硬化 (7.3 [95% CI, 6.8–7.9]) 或心源性栓塞亚型 (7.4 [95% CI, 6.3–8.5])。

在缺血性卒中和糖尿病患者中，复合血管事件的风险与入院 HbA1c 显着相关。入院 HbA1c 的最佳范围低于 6.8%–7.0%，并且因缺血性卒中亚型而异。