Zhang Yi-Na, Wu Qiong, Cui Yu, Zhang Nan-Nan, Chen Hui-Sheng
Department of Neurology General Hospital of Northern Theater Command Shenyang China.
J Am Heart Assoc. 2025 Mar 18;14(6):e037859. doi: 10.1161/JAHA.124.037859. Epub 2025 Mar 13.
Metabolic syndrome (METS) is associated with poor outcomes after acute ischemic stroke. This study aimed to investigate the relationship between METS and efficacy of remote ischemic postconditioning (RIPostC) in acute moderate ischemic stroke using the database of the RICAMIS (Remote Ischemic Conditioning for Acute Moderate Ischemic Stroke) trial.
In the RICAMIS trial, eligible participants were patients with acute moderate ischemic stroke within 48 hours of onset who did not receive reperfusion treatment. A total of 1482 patients were enrolled in this secondary analysis, including the METS (602) and non-METS (880) group according to the METS definitions of the Chinese Diabetes Society, which was further subdivided into RIPostC and control subgroups. The primary outcome was excellent functional outcome, defined as a modified Rankin Scale score of 0 to 1 at 90 days. The differences in clinical outcomes between the RIPostC subgroup and control subgroup were compared in patients with METS or non-METS, respectively, and the interaction effects of RIPostC treatment assignment with METS status were evaluated. The baseline characteristics between RIPostC and control subgroups across patients with METS and non-METS were well balanced, except the difference in Trial of Org 10 172 in Acute Stroke Treatment stroke mechanism in the METS group. Compared with control, RIPostC was associated with high probability of excellent functional outcome in patients with METS (68.8% versus 56.1%; odds ratio [OR], 1.751 [95% CI, 1.248-2.456]; =0.001), but not in patients without METS (66.6% versus 64.6%; OR, 1.103 [95% CI, 0.833-1.461]; =0.494). Notably, a significant interaction effect between treatments (RIPostC or control) by different METS status on excellent functional outcome was observed (=0.039).
The secondary analysis suggests for the first time that RIPostC may provide greater benefit in patients with acute ischemic stroke with METS versus non-METS.
代谢综合征（METS）与急性缺血性卒中后的不良预后相关。本研究旨在利用急性中度缺血性卒中远程缺血预处理（RIPostC）试验（RICAMIS，Remote Ischemic Conditioning for Acute Moderate Ischemic Stroke）数据库，探讨METS与急性中度缺血性卒中患者RIPostC疗效之间的关系。
在RICAMIS试验中，符合条件的参与者为发病48小时内未接受再灌注治疗的急性中度缺血性卒中患者。本二次分析共纳入1482例患者，根据中国糖尿病学会的METS定义分为METS组（602例）和非METS组（880例），每组再进一步分为RIPostC亚组和对照组。主要结局为良好功能结局，定义为90天时改良Rankin量表评分为0至1分。分别比较METS或非METS患者中RIPostC亚组与对照组之间的临床结局差异，并评估RIPostC治疗分组与METS状态的交互作用。METS组和非METS组患者中，RIPostC亚组与对照组之间的基线特征基本均衡，但METS组在急性卒中治疗中组织纤溶酶原激活剂试验（Trial of Org 10 172 in Acute Stroke Treatment）的卒中机制存在差异。与对照组相比，RIPostC使METS患者获得良好功能结局的概率更高（68.8%对56.1%；优势比[OR]，1.751[95%CI，1.248 - 2.456]；P = 0.001），但在非METS患者中并非如此（66.6%对64.6%；OR，1.103[95%CI，0.833 - 1.461]；P = 0.494）。值得注意的是，观察到不同METS状态的治疗（RIPostC或对照）对良好功能结局有显著的交互作用（P = 0.039）。
该二次分析首次表明，与非METS患者相比，RIPostC可能使合并METS的急性缺血性卒中患者获益更大。
