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Minhas, Jatinder S., Wang, Xia, Arima, Hisatomi, Bath, Philip M.W., Billot, Laurent, Broderick, Joseph P., Donnan, Geoffrey A., Kim, Jong S., Lavados, Pablo M., Lee, Tsong-Hai, Martins, Sheila Cristina Ouriques, Olavarría, Verónica V., Pandian, Jeyaraj D., Pontes-Neto, Octávio Marques, Ricci, Stefano, Sato, Shoichiro, Sharma, Vijay K., Thang, Nguyen H., Wang, Ji-Guang, Woodward, Mark, Chalmers, John, Anderson, Craig S. and Robinson, Thompson G. (2018) Lipid-lowering pretreatment and outcome following intravenous thrombolysis for acute ischaemic stroke: a post hoc analysis of the enhanced control of hypertension and thrombolysis stroke study trial. Cerebrovascular Diseases, 45 (5-6). pp. 213-220. ISSN 1421-9786

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Abstract

Background: Debate exists as to whether statin pretreatment confers an increased risk of 90-day mortality and symptomatic intracranial haemorrhage (sICH) in acute ischaemic stroke (AIS) patients treated with intravenous thrombolysis. We assessed the effects of undifferentiated lipid-lowering pretreatment on outcomes and interaction with low-dose versus standard-dose alteplase in a post hoc subgroup ­analysis of the Enhanced Control of Hypertension and Thrombolysis Stroke Study.

Methods: In all, 3,284 thrombolysis-eligible AIS patients (mean age 66.6 years; 38% women), with information on lipid-lowering pretreatment, were randomly assigned to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) intravenous alteplase within 4.5 h of symptom onset. Of the total number of patients, 615 (19%) received statin or other lipid-lowering pretreatment. The primary clinical outcome was combined endpoint of death or disability (modified Rankin Scale scores 2–6) at 90 days.

Results: Compared with patients with no lipid-lowering pretreatment, those with lipid-lowering pretreatment were significantly older, more likely to be non-Asian and more likely to have a medical history including vascular co-morbidity. After propensity analysis assessment and adjustment for important baseline variables at the time of randomisation, as well as imbalances in management during the first 7 days of hospital admission, there were no significant differences in mortality (OR 0.85; 95% CI 0.58–1.25, p = 0.42), or in overall ­90-day death and disability (OR 0.85, 95% CI 0.67–1.09, p = 0.19), despite a significant decrease in sICH among those with ­lipid-lowering pretreatment according to the European Co-operative Acute Stroke Study 2 definition (OR 0.49, 95% CI 0.28–0.83, p = 0.009). No differences in key efficacy or safety outcomes were seen in patients with and without lipid-lowering pretreatment between low- and standard-dose alteplase arms.

Conclusions: Lipid-lowering pretreatment is not associated with adverse outcome in AIS patients treated with intravenous alteplase, whether assessed by 90-day death and disability or death alone.

Item Type:	Article
RIS ID:	https://nottingham-repository.worktribe.com/output/929176
Additional Information:	This is the peer-reviewed but unedited manuscript version of the following article: Minhas J, S, Wang X, Arima H, Bath P, M, Billot L, Broderick J, P, Donnan G, A, Kim J, S, Lavados P, M, Lee T, -H, Martins S, C, O, Olavarría V, V, Pandian J, D, Pontes-Neto O, M, Ricci S, Sato S, Sharma V, K, Thang N, H, Wang J, -G, Woodward M, Chalmers J, Anderson C, S, Robinson T, G, Lipid-Lowering Pretreatment and Outcome Following Intravenous Thrombolysis for Acute Ischaemic Stroke: A Post Hoc Analysis of the Enhanced Control of Hypertension and Thrombolysis Stroke Study Trial. Cerebrovasc Dis 2018; 45:213-220. The final, published version is available at http://www.karger.com/?doi=/10.1159/000488911
Keywords:	Lipid-lowering therapy; Statins; Stroke; Intracranial haemorrhage; Risk factors; Acute stroke outcome
Schools/Departments:	University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Clinical Neuroscience
Identification Number:	https://doi.org/10.1159/000488911
Depositing User:	Eprints, Support
Date Deposited:	04 May 2018 09:00
Last Modified:	04 May 2020 19:34
URI:	https://eprints.nottingham.ac.uk/id/eprint/51567

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