Prior Statin Use, Intracranial Hemorrhage, and Outcome After Intra-Arterial Thrombolysis for Acute Ischemic Stroke
Prior Statin Use, Intracranial Hemorrhage, and Outcome After Intra-Arterial Thrombolysis for Acute Ischemic Stroke
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DOI：
10.1161/strokeaha.108.532473
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发表时间：
2009-05-01
期刊：
影响因子：
8.3
通讯作者：
Arnold, Marcel
中科院分区：
文献类型：
--
作者：
Meier, Niklaus;Nedeltchev, Krassen;Arnold, Marcel
背景和目的：既往他汀类药物使用和/或胆固醇水平是否与颅内出血（ICH）和动脉溶栓后的预后相关，只有有限的数据。本研究的目的是评估他汀类药物预处理和胆固醇水平与脑出血总频率、症状性脑出血频率和3个月临床结局的关系。方法：我们分析了311例连续接受动脉溶栓治疗的患者（平均年龄63岁，其中43%为女性）。结果：18%的患者有他汀类药物预处理。脑出血发生率为20.6%，症状性脑出血发生率为4.8%。脑出血患者更常服用他汀类药物（30%对15%，P=0.005），更常发生房颤（45%对30%，P=0.016），更常发生严重中风（美国国立卫生研究院卒中量表平均评分16.5对14.7，P=0.022），更少出现良好的侧支（16%对24%，P=0.001）。有症状性脑出血的患者更常服用他汀类药物（40%对15%，P=0.009），较少有良好的侧支（0%对24%，P< 0.001）。任何脑出血或症状性脑出血与胆固醇水平无关。多因素分析后，任何脑出血的频率仍然与既往他汀类药物使用（OR, 3.1; 95% CI， 1.53至6.39；P=0.004）、房颤（OR, 2.5； CI， 1.35至4.75；P=0.004）、美国国立卫生研究院卒中量表评分（OR, 1.1； CI， 1.00至1.10；P=0.037）和不良侧络（OR, 1.7； CI， 1.19至2.42；P=0.004）独立相关。结果与既往使用他汀类药物、总胆固醇水平或低密度脂蛋白胆固醇水平没有关联。结论：先前使用他汀类药物，而不是入院时的胆固醇水平，与动脉溶栓后任何脑出血的更高频率相关，但对结果没有影响。（中风。2009;40:1729-1737）
Background and Purpose-There are only limited data on whether prior statin use and/or cholesterol levels are associated with intracranial hemorrhage (ICH) and outcome after intra-arterial thrombolysis. The purpose of this study was to evaluate the association of statin pretreatment and cholesterol levels with the overall frequency of ICH, the frequency of symptomatic ICH, and clinical outcome at 3 months.Methods-We analyzed 311 consecutive patients (mean age, 63 years; 43% women) who received intra-arterial thrombolysis.Results-Statin pretreatment was present in 18%. The frequency of any ICH was 20.6% and of symptomatic ICH 4.8%. Patients with any ICH were more often taking statins (30% versus 15%, P=0.005), more often had atrial fibrillation (45% versus 30%, P=0.016), had more severe strokes ( mean National Institute of Health Stroke Scale score 16.5 versus 14.7, P=0.022), and less often good collaterals (16% versus 24%, P=0.001). Patients with symptomatic ICH were more often taking statins (40% versus 15%, P=0.009) and had less often good collaterals (0% versus 24%, P< 0.001). Any ICH or symptomatic ICH were not associated with cholesterol levels. After multivariate analysis, the frequency of any ICH remained independently associated with previous statin use (OR, 3.1; 95% CI, 1.53 to 6.39; P=0.004), atrial fibrillation (OR, 2.5; CI, 1.35 to 4.75; P=0.004), National Institutes of Health Stroke Scale score (OR, 1.1; CI, 1.00 to 1.10; P=0.037), and worse collaterals (OR, 1.7; CI, 1.19 to 2.42; P=0.004). There was no association of outcome with prior statin use, total cholesterol level, or low-density lipoprotein cholesterol level.Conclusion-Prior statin use, but not cholesterol levels on admission, is associated with a higher frequency of any ICH after intra-arterial thrombolysis without impact on outcome. (Stroke. 2009; 40: 1729-1737.)