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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Statin therapy in acute cardioembolic stroke with no guidance-based indication
Hong-Kyun Park1, Ji Sung Lee1, Keun-Sik Hong1
1From the Department of Neurology (H.-K.P., K.-S.H., Y.-J.C.), Inje University Ilsan Paik Hospital, Goyang; Clinical Research Center (J.S.L.), Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine; Department of Neurology (J.-M.P., K.K.), Nowon Eulji Medical Center, Eulji University, Seoul; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Eulji University, Daejeon; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (M.-K.H., B.J.K., H.-J.B.), Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.-T.K., K.-H.C.), Chonnam National University Hospital, Gwangju; Department of Neurology (D.-E.K., W.-S.R.), Dongguk University Ilsan Hospital, Goyang; Department of Neurology (J.C.C.), Jeju National University Hospital, Jeju National University School of Medicine; Department of Neurology (J.-H.K., W.-J.K.), Ulsan University College of Medicine; Department of Neurology (D.-I.S.), Chungbuk University Hospital, Cheongju; Department of Neurology (S.I.S., J.-H.H.), Keimyung University Dongsan Medical Center, Daegu; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Department of Translational Science and Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine; and Mercy Health Hauenstein Neurosciences (P.B.G.), Grand Rapids, MI.
Objective:
It is uncertain whether patients with cardioembolic stroke and without a guidance-based indication for statin therapy should be administered a statin for prevention of subsequent vascular events. This study was performed to determine whether the statin therapy is beneficial in preventing major vascular events in this population.
Methods:
Using a prospective multicenter stroke registry database, we identified patients with acute cardioembolic stroke who were hospitalized between 2008 and 2015. Patients who had other established indications for statin therapy according to current guidelines were excluded. Major vascular event was defined as a composite of stroke recurrence, myocardial infarction, and vascular death. We performed frailty model analysis with the robust sandwich variance estimator using the stabilized inverse probability of treatment weighting method to estimate hazard ratios of statin therapy on outcomes.
Results:
Of 6,124 patients with cardioembolic stroke, 2,888 (male 44.6%, mean age 75.3 years, 95% confidence interval [CI] 74.8-75.8) were eligible, and 1,863 (64.5%) were on statin therapy during hospitalization. After a median follow-up of 359 days, cumulative incidences of major vascular events were 9.3% in the statin users and 20.5% in the nonusers (p < 0.001 by log-rank test). The adjusted hazard ratios of statin therapy were 0.39 (95% CI 0.31-0.48) for major vascular events, 0.81 (95% CI 0.57-1.16) for stroke recurrence, 0.28 (95% CI 0.21-0.36) for vascular death, and 0.53 (95% CI 0.45-0.61) for all-cause death.
Conclusion:
Starting statin during the acute stage of ischemic stroke may reduce the risk of major vascular events, vascular death, and all-cause death in patients with cardioembolic stroke with no guidance-based indication for statin.
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