Jatinder S. Minhas
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.; 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.; Robinson, Thompson G.
PHILIP BATH firstname.lastname@example.org
Stroke Association Professor of Stroke Medicine
Joseph P. Broderick
Geoffrey A. Donnan
Jong S. Kim
Pablo M. Lavados
Sheila Cristina Ouriques Martins
Verónica V. Olavarría
Jeyaraj D. Pandian
Octávio Marques Pontes-Neto
Vijay K. Sharma
Nguyen H. Thang
Craig S. Anderson
Thompson G. Robinson
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.
Minhas, J. S., Wang, X., Arima, H., Bath, P. M., Billot, L., Broderick, J. P., …Robinson, T. G. (in press). 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), https://doi.org/10.1159/000488911
|Journal Article Type||Article|
|Acceptance Date||Mar 3, 2018|
|Online Publication Date||Apr 27, 2018|
|Deposit Date||May 4, 2018|
|Publicly Available Date||May 4, 2018|
|Peer Reviewed||Peer Reviewed|
|Keywords||Lipid-lowering therapy; Statins; Stroke; Intracranial haemorrhage; Risk factors; Acute stroke outcome|
|Copyright Statement||Copyright information regarding this work can be found at the following address: http://eprints.nottingham.ac.uk/end_user_agreement.pdf|
|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|
ACCEPTED MANUSCRIPT - Lipid-lowering pretreatment.pdf
Copyright information regarding this work can be found at the following address: http://eprints.nottingham.ac.uk/end_user_agreement.pdf
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