Lipid-Lowering Pretreatment and Outcome Following Intravenous Thrombolysis for Acute Ischaemic Stroke: A Post Hoc Analysis of the Enhanced Control of Hypertension and Thrombolysis Stroke Study Trial

Abstract

Background: Debate exists as to whether statin pretreatment confers an increased risk of 90-day mortality and symptomatic intracranial haemorrhage (sICH) in acute ischaemic stroke (AIS) patients treated with intravenous thrombolysis. We assessed the effects of undifferentiated lipid-lowering pretreatment on outcomes and interaction with low-dose versus standard-dose alteplase in a post hoc subgroup ­analysis of the Enhanced Control of Hypertension and Thrombolysis Stroke Study. Methods: In all, 3,284 thrombolysis-eligible AIS patients (mean age 66.6 years; 38% women), with information on lipid-lowering pretreatment, were randomly assigned to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) intravenous alteplase within 4.5 h of symptom onset. Of the total number of patients, 615 (19%) received statin or other lipid-lowering pretreatment. The primary clinical outcome was combined endpoint of death or disability (modified Rankin Scale scores 2–6) at 90 days. Results: Compared with patients with no lipid-lowering pretreatment, those with lipid-lowering pretreatment were significantly older, more likely to be non-Asian and more likely to have a medical history including vascular co-morbidity. After propensity analysis assessment and adjustment for important baseline variables at the time of randomisation, as well as imbalances in management during the first 7 days of hospital admission, there were no significant differences in mortality (OR 0.85; 95% CI 0.58–1.25, p = 0.42), or in overall ­90-day death and disability (OR 0.85, 95% CI 0.67–1.09, p = 0.19), despite a significant decrease in sICH among those with ­lipid-lowering pretreatment according to the European Co-operative Acute Stroke Study 2 definition (OR 0.49, 95% CI 0.28–0.83, p = 0.009). No differences in key efficacy or safety outcomes were seen in patients with and without lipid-lowering pretreatment between low- and standard-dose alteplase arms. Conclusions: Lipid-lowering pretreatment is not associated with adverse outcome in AIS patients treated with intravenous alteplase, whether assessed by 90-day death and disability or death alone.

Prior statin use and intravenous thrombolysis in acute ischemic stroke: a meta-analysis of cohort studies

“…ICH was reported in four studies. 13,14,16,19 The metaanalysis results showed a statistically significant difference between the two groups (OR=1.26; 95% CI, 1.07-1.47; p=0.005) (Figure 5A). There was no statistically significant heterogeneity among the studies (P=0.66; I 2 =0%).…”

“…The heterogeneity was not statistically significant (P=0.64; I 2 =0%). Eight trials 10,[12][13][14][15][16]18,19 reported data on mortality. Mortality rate in the PSU group was 13.3% (309 of 2,332), while that in the NSU group was 12.4% (1,079 of 8,980).…”

“…9 Some studies have reported that prior statin use (PSU) was associated with improved functional outcomes 10,11,14,17,18 , but these findings have not been consistently replicated. 12,13,15,16,19,20 Some studies have shown that statin use before thrombolysis is associated with adverse outcomes such as increased mortality and sICH. Whether it is efficient and safe to combine statins with IVT is still a matter of some controversy.…”

Premorbid Use of Statin and Outcome of Acute Ischemic Stroke After Intravenous Thrombolysis: A Meta-Analysis

“…The characteristics of the included studies are presented in Table 1. Overall, this meta-analysis included 12 prospective cohort studies (10, 11, 13, 14, 16-18, 20-23, 27), five retrospective cohort studies (9,12,15,19,26), and three post-hoc analyses of RCTs (24,25,28), with a total of 20,752 AIS patients who were treated with IVT. The mean ages of the included patients varied between 63 and 75 years, and the baseline NIHSS varied from 7 to 17.…”

Дослідження Ліпопротеїнового Профілю У Пацієнтів Із Мозковим Інсультом У Різні Періоди Захворювання

“…На відміну від інфаркту міокарда, МІ є дуже гетерогенним захворюванням із >150 етіологічними чинниками (Amarenco P. et al, 2009). У сучасних класифікаціях виокремлюють два основних типи МІ: ішемічний (ІІ) та геморагічний інсульт (ГІ), що включає внутрішньо мозковий крововилив (ВМК) та субарахноїдальний крововилив (Sacco R.L. et al, 2013).…”