Gonçalves Ocílio Ribeiro, de Almeida Monteiro Gabriel, Santos Ana B, Hong Anthony, Pereira Maria Antonia Oliveira Machado, Fukunaga Christian Ken, Faria Hilária Saugo, Nogueira Luis Otávio, Ribeiro Filipe Virgilio, Ferreira Márcio Yuri, de Oliveira João Victor Araújo, Almeida Kelson James
Federal University of Piauí, Teresina, Brazil.
Universidade Federal Do Ceará, Fortaleza, Brazil.
Neuroradiology. 2025 Apr;67(4):995-1007. doi: 10.1007/s00234-025-03583-4. Epub 2025 Mar 25.
It remains unclear whether early statin treatment and statin pre-treatment could change prognosis in patients after ischemic stroke undergoing endovascular thrombectomy (EVT).
This study aims to assess whether both statins pretreatment and early statins in-hospital treatment impact the outcomes of patients with acute ischemic stroke (AIS) undergoing EVT.
We systematically searched PubMed, Embase, and Cochrane Central Register of Controlled Trials from inception to June 2024. The early statin use was defined as in-hospital administration of statins post-stroke onset. The statin pre-treatment was defined as the regular use of statins because of any previous indication. The efficacy outcomes were favorable functional outcomes at 90 days, reduced neurological deterioration, and NIHSS improvement greater or equal to 4 points from baseline. We defined a favorable functional outcome as a mRS of 0-2 points. The safety outcomes included symptomatic intracranial hemorrhage (sICH), any ICH, and all-cause death. All statistical analyses were performed using R version 4.4.0.
Seven observational studies comprising 2,440 patients were included. The incidence of favorable functional outcomes (mRS 0-2) in 90 days(RR 1.74; 95% CI 1.38-2.20; p < 0.001; I = 52.4%) was significantly increased in the early statins group compared with the non-statins group. In addition, sICH (RR 0.48; 95% CI 0.29-0.80; p = 0.005; I = 45.2%), any ICH (RR 0.65; 95% CI 0.52-0.81; p < 0.001; I = 0.0%), neurological deterioration (RR 0.36; 95% CI 0.26-0.49; p < 0.001; I = 0%), and death in 90 days (RR 0.38; 95% CI 0.28-0.53; p < 0.001; I = 15%) was significantly lower in the early statins group compared with the non-statins group. No difference between groups in neurological improvement was identified (RR 1.32; 95% CI 0.98-1.78; p = 0.065; I = 66%). In the statins pre-treatment analysis there was no difference between groups in the incidence of successful recanalization (OR 2.62; 95% CI 0.80-8.53; p = 0.11; I = 69%), the incidence of favorable functional outcomes (mRS 0-2) in 90 days (OR 1.53; 95% CI 0.82-2.83; p = 0.18; I = 35%) and neurological improvement (OR 1.35; 95% CI 0.69-2.65; p = 0.38; I = 0%).
This systematic review and meta-analysis identified that early statin treatment is correlated with significant improvement in efficacy and safety outcomes of endovascular thrombectomy. On the other hand, statins pretreatment had no considerable positive impact on outcomes of endovascular thrombectomy.. Large randomized controlled trials are needed to confirm our findings.
目前尚不清楚早期他汀类药物治疗和他汀类药物预处理是否会改变接受血管内血栓切除术（EVT）的缺血性中风患者的预后。
本研究旨在评估他汀类药物预处理和早期住院期间使用他汀类药物是否会影响接受EVT的急性缺血性中风（AIS）患者的预后。
我们系统检索了从创刊至2024年6月的PubMed、Embase和Cochrane对照试验中央注册库。早期他汀类药物使用定义为中风发作后在医院内使用他汀类药物。他汀类药物预处理定义为因任何先前指征而常规使用他汀类药物。疗效结果为90天时良好的功能结局、神经功能恶化减轻以及美国国立卫生研究院卒中量表（NIHSS）较基线改善≥4分。我们将良好的功能结局定义为改良Rankin量表（mRS）评分为0 - 2分。安全结局包括症状性颅内出血（sICH）、任何颅内出血（ICH）和全因死亡。所有统计分析均使用R 4.4.0版本进行。
纳入了7项观察性研究，共2440例患者。与非他汀类药物组相比，早期他汀类药物组90天时良好功能结局（mRS 0 - 2）的发生率显著增加（风险比[RR] 1.74；95%置信区间[CI] 1.38 - 2.20；p < 0.001；I² = 52.4%）。此外，早期他汀类药物组的sICH（RR 0.48；95% CI 0.29 - 0.80；p = 0.005；I² = 45.2%）、任何ICH（RR 0.65；95% CI 0.52 - 0.81；p < 0.001；I² = 0.0%）、神经功能恶化（RR 0.36；95% CI 0.26 - 0.49；p < 0.001；I² = 0%）以及90天内死亡（RR 0.38；95% CI 0.28 - 0.53；p < 0.001；I² = 15%）均显著低于非他汀类药物组。两组在神经功能改善方面未发现差异（RR 1.32；95% CI 0.98 - 1.78；p = 0.065；I² = 66%）。在他汀类药物预处理分析中，两组在成功再通率（比值比[OR] 2.62；95% CI 0.80 - 8.53；p = 0.11；I² = 69%）、90天时良好功能结局（mRS 0 - 2）的发生率（OR 1.53；95% CI 0.82 - 2.83；p = 0.18；I² = 35%）以及神经功能改善（OR 1.35；95% CI 0.69 - 2.65；p = 0.38；I² = 0%）方面均无差异。
本系统评价和荟萃分析表明，早期他汀类药物治疗与血管内血栓切除术的疗效和安全性结局显著改善相关。另一方面，他汀类药物预处理对血管内血栓切除术的结局没有显著的积极影响。需要大型随机对照试验来证实我们的发现。
