Ntaios G, Papavasileiou V, Makaritsis K, Milionis H, Manios E, Michel P, Lip G Y H, Vemmos K
Department of Medicine, University of Thessaly, Larissa, Greece.
Department of Medicine, University of Thessaly, Larissa, Greece.
Int J Cardiol. 2014 Nov 15;177(1):129-33. doi: 10.1016/j.ijcard.2014.09.031. Epub 2014 Sep 28.
BACKGROUND/OBJECTIVES: The most recent ACC/AHA guidelines recommend high-intensity statin therapy in ischemic stroke patients of presumably atherosclerotic origin. On the contrary, there is no specific recommendation for the use of statin in patients with non-atherosclerotic stroke, e.g. strokes related to atrial fibrillation (AF). We investigated whether statin treatment in patients with AF-related stroke is associated with improved survival and reduced risk for stroke recurrence and future cardiovascular events.
All consecutive patients registered in the Athens Stroke Registry with AF-related stroke and no history of coronary artery disease nor clinically manifest peripheral artery disease were included in the analysis and categorized in two groups depending on whether statin was prescribed at discharge. The primary outcome was overall mortality; the secondary outcomes were stroke recurrence and a composite cardiovascular endpoint comprising of recurrent stroke, myocardial infarction, aortic aneurysm rupture or sudden cardiac death during the 5-year follow-up.
Among 1602 stroke patients, 404 (25.2%) with AF-related stroke were included in the analysis, of whom 102 (25.2%) were discharged on statin. On multivariate Cox-proportional-hazards model, statin treatment was independently associated with a lower mortality (hazard-ratio (HR): 0.49, 95%CI:0.26-0.92) and lower risk for the composite cardiovascular endpoint during the median 22 months follow-up (HR: 0.44, 95%CI:0.22-0.88), but not with stroke recurrence (HR: 0.47, 95%CI:0.22-1.01, p: 0.053).
In this long-term registry of patients with AF-related stroke, statin treatment was associated with improved survival and reduced risk for future cardiovascular events.
背景/目的：美国心脏病学会（ACC）/美国心脏协会（AHA）的最新指南建议，对可能由动脉粥样硬化引起的缺血性中风患者进行高强度他汀类药物治疗。相反，对于非动脉粥样硬化性中风患者，如与心房颤动（AF）相关的中风患者，尚无使用他汀类药物的具体建议。我们调查了AF相关中风患者接受他汀类药物治疗是否与生存率提高、中风复发风险降低以及未来心血管事件风险降低相关。
纳入雅典中风登记处登记的所有连续的AF相关中风患者，这些患者无冠状动脉疾病史且无临床明显的外周动脉疾病史，并根据出院时是否开具他汀类药物分为两组。主要结局是全因死亡率；次要结局是中风复发以及一个复合心血管终点，包括5年随访期间的复发性中风、心肌梗死、主动脉瘤破裂或心源性猝死。
在1602例中风患者中，404例（25.2%）为AF相关中风患者纳入分析，其中102例（25.2%）出院时使用他汀类药物。在多变量Cox比例风险模型中，他汀类药物治疗与较低的死亡率独立相关（风险比（HR）：0.49，95%置信区间（CI）：0.26 - 0.92），并且在中位22个月的随访期间与复合心血管终点的较低风险相关（HR：0.44，95%CI：0.22 - 0.88），但与中风复发无关（HR：0.47，95%CI：0.22 - 1.01，p：0.053）。
在这个AF相关中风患者的长期登记研究中，他汀类药物治疗与生存率提高以及未来心血管事件风险降低相关。
