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

Minhas, Jatinder S. and Wang, Xia and Arima, Hisatomi and Bath, Philip M.W. and Billot, Laurent and Broderick, Joseph P. and Donnan, Geoffrey A. and Kim, Jong S. and Lavados, Pablo M. and Lee, Tsong-Hai and Martins, Sheila Cristina Ouriques and Olavarría, Verónica V. and Pandian, Jeyaraj D. and Pontes-Neto, Octávio Marques and Ricci, Stefano and Sato, Shoichiro and Sharma, Vijay K. and Thang, Nguyen H. and Wang, Ji-Guang and Woodward, Mark and Chalmers, John and 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: http://eprints.nottingham.ac.uk/id/eprint/51567

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