Reduction in early stroke risk in carotid stenosis with transient ischemic attack associated with statin treatment.
Reduction in early stroke risk in carotid stenosis with transient ischemic attack associated with statin treatment.
复制标题
与他汀类药物治疗相关的短暂性缺血性攻击，颈动脉狭窄的早期中风风险降低。
DOI：
10.1161/strokeaha.113.001576
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发表时间：
2013-10
期刊：
影响因子：
8.3
通讯作者：
Kelly PJ
中科院分区：
文献类型：
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作者：
Merwick Á;Albers GW;Arsava EM;Ay H;Calvet D;Coutts SB;Cucchiara BL;Demchuk AM;Giles MF;Mas JL;Olivot JM;Purroy F;Rothwell PM;Saver JL;Sharma VK;Tsivgoulis G;Kelly PJ
他汀类药物在 TIA/中风数月后开始使用可降低中风风险，并可能通过多效性斑块稳定作用减少急性冠状动脉综合征的早期血管事件。关于 TIA 急性使用他汀类药物的数据很少。我们的目的是确定 TIA 发作时他汀类药物预处理是否可以改变颈动脉狭窄的早期卒中风险。我们分析了来自 11 个中心的 2770 名 TIA 患者的数据，其中 387 名患者患有同侧颈动脉狭窄。记录ABCD2评分、异常DWI、药物治疗前和早期卒中。在颈动脉狭窄患者中，7 天卒中风险为 8.3%（95% 置信区间 [CI] 5.7–11.1），而无颈动脉狭窄患者的 7 天卒中风险为 2.7% [CI 2.0–3.4%]（p<0.0001）（90 天风险分别为 17.8% 和 5.7% [p<0.0001]）。在颈动脉狭窄患者中，TIA 发作时接受他汀类药物治疗的非手术 7 天卒中风险为 3.8% [CI 1.2–9.7%]，而未接受他汀类药物治疗的患者的非手术 7 天卒中风险为 13.2% [CI 8.5–19.8%] (p=0.01)（90 天风险分别为 8.9% 与 20.8% [p=0.01]）。他汀类药物预治疗与颈动脉狭窄患者中风风险降低相关（90天中风OR为0.37，CI 0.17-0.82），但与非狭窄患者无关（OR 1.3，CI 0.8-2.24）（交互作用p为0.008）。在多变量逻辑回归中，调整 ABCD2 评分、吸烟、抗血小板治疗、近期 TIA 和 DWI 高信号后，相关性仍然存在（交互作用调整 p 为 0.054）。在急性症状性颈动脉狭窄中，他汀类药物预治疗可降低中风风险，这与急性冠状动脉综合征随机试验的结果一致。这些数据支持这样的假设：TIA 症状出现后立即开始使用他汀类药物也可能有益于预防早期中风。需要进行随机试验来解决这个问题。
Statins reduce stroke risk when initiated months after TIA/stroke and reduce early vascular events in acute coronary syndromes, possibly via pleiotropic plaque-stabilisation. Few data exist regarding acute statin use in TIA. We aimed to determine if statin pre-treatment at TIA onset modified early stroke risk in carotid stenosis. We analyzed data from 2770 TIA patients from 11 centres, 387 with ipsilateral carotid stenosis. ABCD2 score, abnormal DWI, medication pre-treatment, and early stroke were recorded. In patients with carotid stenosis, 7-day stroke risk was 8.3% (95% confidence interval [CI] 5.7–11.1) compared with 2.7% [CI 2.0–3.4%] without stenosis (p<0.0001) (90-day risks 17.8% and 5.7% [p<0.0001]). Among carotid stenosis patients, non-procedural 7-day stroke risk was 3.8% [CI 1.2–9.7%] with statin treatment at TIA onset, compared to 13.2% [CI 8.5–19.8%] in those not statin pre-treated (p=0.01) (90-day risks 8.9% versus 20.8% [p=0.01]). Statin pre-treatment was associated with reduced stroke risk in carotid stenosis patients (OR for 90-day stroke 0.37, CI 0.17–0.82), but not non-stenosis patients (OR 1.3, CI 0.8–2.24) (p for interaction 0.008). On multivariable logistic regression, the association remained after adjustment for ABCD2 score, smoking, antiplatelet treatment, recent TIA, and DWI hyperintensity (adjusted p for interaction 0.054). In acute symptomatic carotid stenosis, statin pre-treatment was associated with reduced stroke risk, consistent with findings from randomized trials in acute coronary syndromes. These data support the hypothesis that statins started acutely after TIA symptom onset may also be beneficial to prevent early stroke. Randomized trials addressing this question are required.