Effect of statin use on clinical outcomes in ischemic stroke patients with atrial fibrillation.
Effect of statin use on clinical outcomes in ischemic stroke patients with atrial fibrillation.
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DOI：
10.1097/md.0000000000005918
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发表时间：
2017-02
期刊：
影响因子：
1.6
通讯作者：
Ovbiagele B
中科院分区：
文献类型：
--
作者：
Wu YL;Saver JL;Chen PC;Lee JD;Wang HH;Rao NM;Lee M;Ovbiagele B
目前尚不清楚他汀类药物治疗是否应应用于缺血性卒中伴房颤患者。本研究的目的是阐明他汀类药物治疗是否会影响近期缺血性卒中伴房颤患者的预后。我们从台湾全民健康保险数据库中识别了2001年至2011年期间患有房颤的缺血性卒中患者。根据年龄、性别、高血压、糖尿病、缺血性心脏病、心力衰竭、估计的美国国立卫生研究院卒中量表、抗凝剂使用情况和进入队列的年份，将在索引卒中后前90天内未接受他汀类药物治疗的患者与在前90天内接受他汀类药物治疗的患者以2：1的比例进行匹配。主要结局为首次卒中复发事件，次要结局为院内死亡。共有1546名在卒中后前90天接受他汀类药物治疗的房颤患者和3092名匹配的房颤非他汀类对照者入选本分析。在中位2.4年随访期间，接受与未接受他汀类药物治疗的受试者之间复发性卒中的风险没有差异（风险比= 1.01，95%置信区间0.88至1.15）。 然而，在长期随访期间，接受他汀类药物治疗的房颤患者在任何住院期间的死亡风险降低（风险比= 0.74，95%置信区间0.61至0.89）。 在伴有房颤的缺血性卒中患者中，在卒中后急性期至亚急性期开始他汀类药物治疗并不能改变卒中复发率，但与院内死亡率降低相关。
It remains unclear whether statin therapy should be applied to ischemic stroke patients with atrial fibrillation. The objective of this study was to clarify whether statin therapy can influence the prognosis in recent ischemic stroke patients with atrial fibrillation. We identified ischemic stroke patients with atrial fibrillation between 2001 and 2011 from Taiwan National Health Insurance Database. Patients not treated with statins during the first 90 days after the index stroke were matched to patients treated with statins in the first 90 days in a 2:1 ratio on the basis of age, sex, hypertension, diabetes mellitus, ischemic heart disease, heart failure, estimated National Institutes of Health Stroke Scale, use of anticoagulant, and year of their entry into the cohort. The primary outcome was the first event of recurrent stroke, and the secondary outcome was in-hospital death. A total of 1546 atrial fibrillation patients with statin therapy in the first 90 days poststroke and 3092 matched atrial fibrillation nonstatin controls were enrolled for this analysis. During the median 2.4-year follow-up, the risk of recurrent stroke was not different between subjects receiving versus not receiving statin therapy (hazard ratios = 1.01, 95% confidence interval 0.88 to 1.15). However, patients with atrial fibrillation receiving statin therapy had a reduced risk for death during any hospitalization throughout the long-term follow-up period (hazard ratios = 0.74, 95% confidence interval 0.61 to 0.89). Among ischemic stroke patients with atrial fibrillation, statin therapy initiated during the acute to subacute poststroke stage did not alter the rate of stroke recurrence but was associated with a decreased rate of in-hospital death.