Pan Boyan, Lan Jiaying, Li Xiaojun, Chen Haoxuan, Weng Luankun, Xu Haoyou, Zhao Yuanqi, Zhao Min
The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China.
Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Zhongshan, China.
Front Pharmacol. 2025 Jun 4;16:1533905. doi: 10.3389/fphar.2025.1533905. eCollection 2025.
To evaluate the relationship between early statin administration and hemorrhagic transformation (HT) in patients with acute ischemic stroke (AIS) patients following recanalization therapy.
This retrospective study included AIS patients who underwent recanalization therapy (intravenous thrombolysis, endovascular treatment, or a combination of both) and categorized them into two groups based on whether statins were administered within 24 h of recanalization therapy. The primary outcome was the occurrence of HT during hospitalization. Secondary outcomes included in-hospital mortality, favorable clinical outcomes (mRS 0-2) at discharge, and neurological improvement 7 ± 2 days post-stroke (defined as a reduction of ≥4 points in NIHSS from baseline).
A total of 266 AIS patients were analyzed, with 164 (61.7%) receiving statins within 24 h (24 h-statins group). The 24 h-statins group demonstrated a significantly lower risk of HT compared to the non-24 h-statins group (4.9% vs. 21.6%, p < 0.001). In-hospital mortality was also lower in the 24 h-statins group, although not statistically significant (4.9% vs. 10.8%, p = 0.076). Favorable clinical outcomes were more frequent in the 24 h-statins group than in the non-24 h-statins group (60.5% vs. 36.7%, p < 0.001). Furthermore, a greater proportion of patients in the 24 h-statins group showed neurological improvement (51.8% vs. 35.1%, p = 0.019). Adjusted multivariate analysis revealed that early statin use was independently associated with a reduced risk of HT (OR 0.16, 95% CI 0.06-0.49, p < 0.001), as well as a positive association with favorable clinical outcomes (OR 3.63, 95% CI 1.42-9.28, p = 0.007) and neurological improvement (OR 5.23, 95% CI 1.96-13.91, p < 0.001). Subgroup analysis indicated that among patients with elevated low-density lipoprotein (LDL) levels, early statin therapy was linked to a lower risk of HT (P for interaction = 0.018).
Early statin administration within 24 h of recanalization therapy, in AIS patients was associated with reduced risk of HT and improved neurological outcomes. For patients with elevated LDL levels, early statin therapy may further decrease the risk of HT.
评估急性缺血性卒中（AIS）患者再通治疗后早期使用他汀类药物与出血性转化（HT）之间的关系。
这项回顾性研究纳入了接受再通治疗（静脉溶栓、血管内治疗或两者联合）的AIS患者，并根据他汀类药物是否在再通治疗后24小时内使用将他们分为两组。主要结局是住院期间发生HT。次要结局包括院内死亡率、出院时良好的临床结局（改良Rankin量表评分0 - 2分）以及卒中后7±2天的神经功能改善（定义为美国国立卫生研究院卒中量表[NIHSS]较基线降低≥4分）。
共分析了266例AIS患者，其中164例（61.7%）在24小时内接受了他汀类药物治疗（24小时他汀类药物组）。与非24小时他汀类药物组相比，24小时他汀类药物组发生HT的风险显著更低（4.9%对21.6%，p<0.001）。24小时他汀类药物组的院内死亡率也更低，尽管无统计学意义（4.9%对10.8%，p = 0.076）。24小时他汀类药物组的良好临床结局比非24小时他汀类药物组更常见（60.5%对36.7%，p<0.001）。此外，24小时他汀类药物组中显示神经功能改善的患者比例更高（51.8%对35.1%，p = 0.019）。多因素校正分析显示，早期使用他汀类药物与HT风险降低独立相关（比值比[OR]0.16，95%置信区间[CI]0.06 - 0.49，p<0.001），并且与良好的临床结局呈正相关（OR 3.63，95%CI 1.42 - 9.28，p = 0.007）以及神经功能改善（OR 5.23，95%CI 1.96 - 13.91，p<0.001）。亚组分析表明，在低密度脂蛋白（LDL）水平升高的患者中，早期他汀类药物治疗与较低的HT风险相关（交互作用P值 = 0.018）。
AIS患者再通治疗后24小时内早期使用他汀类药物与HT风险降低及神经功能结局改善相关。对于LDL水平升高的患者，早期他汀类药物治疗可能进一步降低HT风险。
