Statin pretreatment is associated with better outcomes in large artery atherosclerotic stroke

Georgios Tsivgoulis, Aristeidis H. Katsanos, Vijay K. Sharma, Christos Krogias, Robert Mikulik, Konstantinos Vadikolias, Milija Mijajlovic, Apostolos Safouris, Christina Zompola, Simon Faissner, Viktor Weiss, Sotirios Giannopoulos, Spyros Vasdekis, Efstathios Boviatsis, Anne Alexandrov, Konstantinos Voumvourakis, Andrei Alexandrov

Research output: Contribution to journalArticle

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Abstract

Objective: Even though statin pretreatment is associated with better functional outcomes and lower risk of mortality in acute ischemic stroke, there are limited data evaluating this association in acute ischemic stroke due to large artery atherosclerosis (LAA), which carries the highest risk of early stroke recurrence. Methods: Consecutive patients with acute LAA were prospectively evaluated from 7 tertiary-care stroke centers during a 3-year period. Statin pretreatment, demographics, vascular risk factors, and admission and discharge stroke severity were recorded. The outcome events of interest were neurologic improvement during hospitalization (quantified as the relative decrease in NIH Stroke Scale score at discharge in comparison to hospital admission), favorable functional outcome (FFO) (defined as modified Rankin Scale score of 0-1), recurrent stroke, and death at 1 month. Statistical analyses were performed using univariable and multivariable Cox regression models adjusting for potential confounders. All analyses were repeated following propensity score matching. Results: Statin pretreatment was documented in 192 (37.2%) of 516 consecutive patients with LAA (mean age: 65 ± 13 years; 60.8% men; median NIH Stroke Scale score: 9 points, interquartile range: 5-18). Statin pretreatment was associated with greater neurologic improvement during hospitalization and higher rates of 30-day FFO in unmatched and matched (odds ratio for FFO: 2.44; 95% confidence interval [CI]: 1.07-5.53) analyses. It was also related to lower risk of 1-month mortality and stroke recurrence in unmatched and matched analyses (hazard ratio for recurrent stroke: 0.11, 95% CI: 0.02-0.46; hazard ratio for death: 0.24, 95% CI: 0.08-0.75). Conclusion: Statin pretreatment in patients with acute LAA appears to be associated with better early outcomes regarding neurologic improvement, disability, survival, and stroke recurrence.

Original languageEnglish (US)
Pages (from-to)1103-1111
Number of pages9
JournalNeurology
Volume86
Issue number12
DOIs
StatePublished - Mar 22 2016

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Arteries
Stroke
Atherosclerosis
Nervous System
Confidence Intervals
Recurrence
Hospitalization
Propensity Score
Mortality
Proportional Hazards Models
Tertiary Care Centers
Odds Ratio
Demography

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

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Statin pretreatment is associated with better outcomes in large artery atherosclerotic stroke. / Tsivgoulis, Georgios; Katsanos, Aristeidis H.; Sharma, Vijay K.; Krogias, Christos; Mikulik, Robert; Vadikolias, Konstantinos; Mijajlovic, Milija; Safouris, Apostolos; Zompola, Christina; Faissner, Simon; Weiss, Viktor; Giannopoulos, Sotirios; Vasdekis, Spyros; Boviatsis, Efstathios; Alexandrov, Anne; Voumvourakis, Konstantinos; Alexandrov, Andrei.

In: Neurology, Vol. 86, No. 12, 22.03.2016, p. 1103-1111.

Research output: Contribution to journalArticle

Tsivgoulis, G, Katsanos, AH, Sharma, VK, Krogias, C, Mikulik, R, Vadikolias, K, Mijajlovic, M, Safouris, A, Zompola, C, Faissner, S, Weiss, V, Giannopoulos, S, Vasdekis, S, Boviatsis, E, Alexandrov, A, Voumvourakis, K & Alexandrov, A 2016, 'Statin pretreatment is associated with better outcomes in large artery atherosclerotic stroke', Neurology, vol. 86, no. 12, pp. 1103-1111. https://doi.org/10.1212/WNL.0000000000002493
Tsivgoulis, Georgios ; Katsanos, Aristeidis H. ; Sharma, Vijay K. ; Krogias, Christos ; Mikulik, Robert ; Vadikolias, Konstantinos ; Mijajlovic, Milija ; Safouris, Apostolos ; Zompola, Christina ; Faissner, Simon ; Weiss, Viktor ; Giannopoulos, Sotirios ; Vasdekis, Spyros ; Boviatsis, Efstathios ; Alexandrov, Anne ; Voumvourakis, Konstantinos ; Alexandrov, Andrei. / Statin pretreatment is associated with better outcomes in large artery atherosclerotic stroke. In: Neurology. 2016 ; Vol. 86, No. 12. pp. 1103-1111.
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title = "Statin pretreatment is associated with better outcomes in large artery atherosclerotic stroke",
abstract = "Objective: Even though statin pretreatment is associated with better functional outcomes and lower risk of mortality in acute ischemic stroke, there are limited data evaluating this association in acute ischemic stroke due to large artery atherosclerosis (LAA), which carries the highest risk of early stroke recurrence. Methods: Consecutive patients with acute LAA were prospectively evaluated from 7 tertiary-care stroke centers during a 3-year period. Statin pretreatment, demographics, vascular risk factors, and admission and discharge stroke severity were recorded. The outcome events of interest were neurologic improvement during hospitalization (quantified as the relative decrease in NIH Stroke Scale score at discharge in comparison to hospital admission), favorable functional outcome (FFO) (defined as modified Rankin Scale score of 0-1), recurrent stroke, and death at 1 month. Statistical analyses were performed using univariable and multivariable Cox regression models adjusting for potential confounders. All analyses were repeated following propensity score matching. Results: Statin pretreatment was documented in 192 (37.2{\%}) of 516 consecutive patients with LAA (mean age: 65 ± 13 years; 60.8{\%} men; median NIH Stroke Scale score: 9 points, interquartile range: 5-18). Statin pretreatment was associated with greater neurologic improvement during hospitalization and higher rates of 30-day FFO in unmatched and matched (odds ratio for FFO: 2.44; 95{\%} confidence interval [CI]: 1.07-5.53) analyses. It was also related to lower risk of 1-month mortality and stroke recurrence in unmatched and matched analyses (hazard ratio for recurrent stroke: 0.11, 95{\%} CI: 0.02-0.46; hazard ratio for death: 0.24, 95{\%} CI: 0.08-0.75). Conclusion: Statin pretreatment in patients with acute LAA appears to be associated with better early outcomes regarding neurologic improvement, disability, survival, and stroke recurrence.",
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T1 - Statin pretreatment is associated with better outcomes in large artery atherosclerotic stroke

AU - Tsivgoulis, Georgios

AU - Katsanos, Aristeidis H.

AU - Sharma, Vijay K.

AU - Krogias, Christos

AU - Mikulik, Robert

AU - Vadikolias, Konstantinos

AU - Mijajlovic, Milija

AU - Safouris, Apostolos

AU - Zompola, Christina

AU - Faissner, Simon

AU - Weiss, Viktor

AU - Giannopoulos, Sotirios

AU - Vasdekis, Spyros

AU - Boviatsis, Efstathios

AU - Alexandrov, Anne

AU - Voumvourakis, Konstantinos

AU - Alexandrov, Andrei

PY - 2016/3/22

Y1 - 2016/3/22

N2 - Objective: Even though statin pretreatment is associated with better functional outcomes and lower risk of mortality in acute ischemic stroke, there are limited data evaluating this association in acute ischemic stroke due to large artery atherosclerosis (LAA), which carries the highest risk of early stroke recurrence. Methods: Consecutive patients with acute LAA were prospectively evaluated from 7 tertiary-care stroke centers during a 3-year period. Statin pretreatment, demographics, vascular risk factors, and admission and discharge stroke severity were recorded. The outcome events of interest were neurologic improvement during hospitalization (quantified as the relative decrease in NIH Stroke Scale score at discharge in comparison to hospital admission), favorable functional outcome (FFO) (defined as modified Rankin Scale score of 0-1), recurrent stroke, and death at 1 month. Statistical analyses were performed using univariable and multivariable Cox regression models adjusting for potential confounders. All analyses were repeated following propensity score matching. Results: Statin pretreatment was documented in 192 (37.2%) of 516 consecutive patients with LAA (mean age: 65 ± 13 years; 60.8% men; median NIH Stroke Scale score: 9 points, interquartile range: 5-18). Statin pretreatment was associated with greater neurologic improvement during hospitalization and higher rates of 30-day FFO in unmatched and matched (odds ratio for FFO: 2.44; 95% confidence interval [CI]: 1.07-5.53) analyses. It was also related to lower risk of 1-month mortality and stroke recurrence in unmatched and matched analyses (hazard ratio for recurrent stroke: 0.11, 95% CI: 0.02-0.46; hazard ratio for death: 0.24, 95% CI: 0.08-0.75). Conclusion: Statin pretreatment in patients with acute LAA appears to be associated with better early outcomes regarding neurologic improvement, disability, survival, and stroke recurrence.

AB - Objective: Even though statin pretreatment is associated with better functional outcomes and lower risk of mortality in acute ischemic stroke, there are limited data evaluating this association in acute ischemic stroke due to large artery atherosclerosis (LAA), which carries the highest risk of early stroke recurrence. Methods: Consecutive patients with acute LAA were prospectively evaluated from 7 tertiary-care stroke centers during a 3-year period. Statin pretreatment, demographics, vascular risk factors, and admission and discharge stroke severity were recorded. The outcome events of interest were neurologic improvement during hospitalization (quantified as the relative decrease in NIH Stroke Scale score at discharge in comparison to hospital admission), favorable functional outcome (FFO) (defined as modified Rankin Scale score of 0-1), recurrent stroke, and death at 1 month. Statistical analyses were performed using univariable and multivariable Cox regression models adjusting for potential confounders. All analyses were repeated following propensity score matching. Results: Statin pretreatment was documented in 192 (37.2%) of 516 consecutive patients with LAA (mean age: 65 ± 13 years; 60.8% men; median NIH Stroke Scale score: 9 points, interquartile range: 5-18). Statin pretreatment was associated with greater neurologic improvement during hospitalization and higher rates of 30-day FFO in unmatched and matched (odds ratio for FFO: 2.44; 95% confidence interval [CI]: 1.07-5.53) analyses. It was also related to lower risk of 1-month mortality and stroke recurrence in unmatched and matched analyses (hazard ratio for recurrent stroke: 0.11, 95% CI: 0.02-0.46; hazard ratio for death: 0.24, 95% CI: 0.08-0.75). Conclusion: Statin pretreatment in patients with acute LAA appears to be associated with better early outcomes regarding neurologic improvement, disability, survival, and stroke recurrence.

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