Ko Darae, Thigpen Jonathan L, Otis James A, Forster Kristen, Henault Lori, Quinn Emily, Tripodis Yorghos, Berger Peter B, Limdi Nita, Hylek Elaine M
Department of Medicine, Boston University School of Medicine, Boston, MA, United States.
Department of Clinical and Administrative Sciences, Notre Dame of Maryland School of Pharmacy, Baltimore, MD, United States.
Int J Cardiol. 2017 Jan 15;227:808-812. doi: 10.1016/j.ijcard.2016.10.055. Epub 2016 Oct 24.
Statin pretreatment has been associated with reduced infarct volume in nonlacunar strokes. The effect of statins on functional outcomes of strokes related to atrial fibrillation (AF) is unknown. We aimed to define the influence of prestroke statin use on functional outcome in AF.
We assembled a cohort of consecutive ischemic stroke patients from 2006 to 2010. All patients underwent CT or MRI and were adjudicated by site investigators. AF was confirmed by electrocardiogram in 100% of patients. Site neurologists blinded to the study hypothesis affirmed the type of stroke and assessed the severity of disability at the time of hospital discharge. The frequency of death at 30-days was calculated.
Ischemic stroke (n=1030) resulted in a severe neurological deficit or death (modified Rankin scale ≥4) at 30days in 711 patients (69%). Using multivariable logistic regression models adjusting for factors associated with statin treatment and factors associated with functional outcome, prestroke statin use was associated with a 32% reduction in frequency of severe stroke (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.50-0.92; P=0.011). Other independent factors associated with severe stroke included older age, female sex, non-White race, diabetes mellitus, prior ischemic stroke, prior venous thromboembolism, and dementia.
Ischemic strokes in AF are associated with high mortality and morbidity. Statin use at time of stroke onset among patients with AF was associated in this study with less severe stroke and warrant validation.
他汀类药物预处理与非腔隙性卒中梗死体积减小有关。他汀类药物对心房颤动（AF）相关卒中功能结局的影响尚不清楚。我们旨在确定卒中前使用他汀类药物对AF患者功能结局的影响。
我们收集了2006年至2010年连续的缺血性卒中患者队列。所有患者均接受了CT或MRI检查，并由现场研究人员进行判定。100%的患者通过心电图确诊为AF。对研究假设不知情的现场神经科医生确认了卒中类型，并评估了出院时的残疾严重程度。计算30天的死亡频率。
1030例缺血性卒中患者中，711例（69%）在30天时出现严重神经功能缺损或死亡（改良Rankin量表≥4）。使用多变量逻辑回归模型，对与他汀类药物治疗相关的因素和与功能结局相关的因素进行调整后，卒中前使用他汀类药物与严重卒中频率降低32%相关（优势比[OR]，0.68；95%置信区间[CI]，0.50 - 0.92；P = 0.011）。与严重卒中相关的其他独立因素包括年龄较大、女性、非白人种族、糖尿病、既往缺血性卒中、既往静脉血栓栓塞和痴呆。
AF患者的缺血性卒中与高死亡率和高发病率相关。本研究中，AF患者卒中发作时使用他汀类药物与较轻的卒中相关，有待验证。
