EXPRESS: Association of statin pretreatment with baseline stroke severity and outcome in patients with acute ischemic stroke: an observational study

Escudero-Martínez I, Matusevicius M, Nunes AP, Ševčík P, Nevsimalova M, Rand VM, Kõrv J, Cappellari M, Mikulik R, Toni D, Ahmed N.

Int J Stroke. 2022 Apr 11:17474930221095965. doi: 10.1177/17474930221095965. Epub ahead of print. PMID:35403505.


9 May 2022

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ABSTRACTBackground:Statins have an important role in stroke prevention, especially in high-risk populations and may also affect the initial stroke severity and outcomes in patients taking them before an ischemic stroke.

Aims: Our aim was to evaluate the association of statin pretreatment with the severity in acute ischemic stroke (AIS).

Methods: We analyzed SITS International Thrombolysis and Thrombectomy Registry data from January 2011 to December 2017. We identified patients with statin information at baseline. The primary outcome was baseline NIH stroke scale (NIHSS) score. Secondary outcomes were NIHSS score at 24 hours, symptomatic intracerebral hemorrhage (SICH) and functional outcome at 90 days after acute intervention. Multivariable linear and logistic regression and propensity score matching (PSM) was used to quantify the effect of statin pretreatment.

Results: Of 93849 patients, 23651 (25.2%) were treated with statins prior the AIS. Statin pretreatment group was older and had higher comorbidity. Median NIHSS at baseline was similar between groups. In the adjusted and PSM analysis, statin pretreatment was inversely associated with baseline NIHSS (OR 0.77,95%CI 0.6-0.99 and OR for PSM 0.73,95%CI 0.54-0.99,p=0.004) and independently associated with mild stroke defined as NIHSS≤8 in PSM analysis (OR 1.084,95%CI 1.012-1.161,p=0.022). Regarding secondary outcomes, there were no differences in functional outcomes, death nor SICH rates between groups.

Conclusions: Prior treatment with statins was associated with lower NIHSS at baseline. However, this association did not translate into any difference regarding functional outcome at 90 days. No association was found regarding SICH. These findings indicate the need of further studies to assess the effect on statin pretreatment on initial stroke severity.Data access statement: All data relevant to the study are included in the article or uploaded as supplementary.

Keywords: Lipids; Neuroprotection; Prevention; Severity; Statins; Stroke.

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