Georgios Tsivgoulis1, Aristeidis H Katsanos2, Vijay K Sharma2, Christos Krogias2, Robert Mikulik2, Konstantinos Vadikolias2, Milija Mijajlovic2, Apostolos Safouris2, Christina Zompola2, Simon Faissner2, Viktor Weiss2, Sotirios Giannopoulos2, Spyros Vasdekis2, Efstathios Boviatsis2, Anne W Alexandrov2, Konstantinos Voumvourakis2, Andrei V Alexandrov2. 1. From the Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., K.Voumvourakis), Attikon University Hospital, School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T., R.M., V.W.), St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K., S.G.), University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (C.K., S.F.), St. Josef-Hospital, Ruhr University, Bochum, Germany; Neurology Department (R.M., V.W.), St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.Vadikolias), University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; Neurology Clinic (M.M.), Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia; Stroke Unit (A.S.), Department of Neurology, Brugmann University Hospital, Brussels, Belgium; Departments of Vascular Surgery (S.V.) and Neurosurgery (E.B.), Attikon University Hospital, University of Athens, Greece; and Australian Catholic University (A.W.A.), Sydney, Australia. tsivgoulisgiorg@yahoo.gr. 2. From the Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., K.Voumvourakis), Attikon University Hospital, School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T., R.M., V.W.), St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K., S.G.), University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (C.K., S.F.), St. Josef-Hospital, Ruhr University, Bochum, Germany; Neurology Department (R.M., V.W.), St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.Vadikolias), University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; Neurology Clinic (M.M.), Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia; Stroke Unit (A.S.), Department of Neurology, Brugmann University Hospital, Brussels, Belgium; Departments of Vascular Surgery (S.V.) and Neurosurgery (E.B.), Attikon University Hospital, University of Athens, Greece; and Australian Catholic University (A.W.A.), Sydney, Australia.
Abstract
OBJECTIVE: Even though statin pretreatment is associated with better functional outcomes and lower risk of mortality in acute ischemic stroke, there are limited data evaluating this association in acute ischemic stroke due to large artery atherosclerosis (LAA), which carries the highest risk of early stroke recurrence. METHODS: Consecutive patients with acute LAA were prospectively evaluated from 7 tertiary-care stroke centers during a 3-year period. Statin pretreatment, demographics, vascular risk factors, and admission and discharge stroke severity were recorded. The outcome events of interest were neurologic improvement during hospitalization (quantified as the relative decrease in NIH Stroke Scale score at discharge in comparison to hospital admission), favorable functional outcome (FFO) (defined as modified Rankin Scale score of 0-1), recurrent stroke, and death at 1 month. Statistical analyses were performed using univariable and multivariable Cox regression models adjusting for potential confounders. All analyses were repeated following propensity score matching. RESULTS: Statin pretreatment was documented in 192 (37.2%) of 516 consecutive patients with LAA (mean age: 65 ± 13 years; 60.8% men; median NIH Stroke Scale score: 9 points, interquartile range: 5-18). Statin pretreatment was associated with greater neurologic improvement during hospitalization and higher rates of 30-day FFO in unmatched and matched (odds ratio for FFO: 2.44; 95% confidence interval [CI]: 1.07-5.53) analyses. It was also related to lower risk of 1-month mortality and stroke recurrence in unmatched and matched analyses (hazard ratio for recurrent stroke: 0.11, 95% CI: 0.02-0.46; hazard ratio for death: 0.24, 95% CI: 0.08-0.75). CONCLUSION: Statin pretreatment in patients with acute LAA appears to be associated with better early outcomes regarding neurologic improvement, disability, survival, and stroke recurrence.
OBJECTIVE: Even though statin pretreatment is associated with better functional outcomes and lower risk of mortality in acute ischemic stroke, there are limited data evaluating this association in acute ischemic stroke due to large artery atherosclerosis (LAA), which carries the highest risk of early stroke recurrence. METHODS: Consecutive patients with acute LAA were prospectively evaluated from 7 tertiary-care stroke centers during a 3-year period. Statin pretreatment, demographics, vascular risk factors, and admission and discharge stroke severity were recorded. The outcome events of interest were neurologic improvement during hospitalization (quantified as the relative decrease in NIH Stroke Scale score at discharge in comparison to hospital admission), favorable functional outcome (FFO) (defined as modified Rankin Scale score of 0-1), recurrent stroke, and death at 1 month. Statistical analyses were performed using univariable and multivariable Cox regression models adjusting for potential confounders. All analyses were repeated following propensity score matching. RESULTS: Statin pretreatment was documented in 192 (37.2%) of 516 consecutive patients with LAA (mean age: 65 ± 13 years; 60.8% men; median NIH Stroke Scale score: 9 points, interquartile range: 5-18). Statin pretreatment was associated with greater neurologic improvement during hospitalization and higher rates of 30-day FFO in unmatched and matched (odds ratio for FFO: 2.44; 95% confidence interval [CI]: 1.07-5.53) analyses. It was also related to lower risk of 1-month mortality and stroke recurrence in unmatched and matched analyses (hazard ratio for recurrent stroke: 0.11, 95% CI: 0.02-0.46; hazard ratio for death: 0.24, 95% CI: 0.08-0.75). CONCLUSION: Statin pretreatment in patients with acute LAA appears to be associated with better early outcomes regarding neurologic improvement, disability, survival, and stroke recurrence.
Authors: Thomas G Brott; Jonathan L Halperin; Suhny Abbara; J Michael Bacharach; John D Barr; Ruth L Bush; Christopher U Cates; Mark A Creager; Susan B Fowler; Gary Friday; Vicki S Hertzberg; E Bruce McIff; Wesley S Moore; Peter D Panagos; Thomas S Riles; Robert H Rosenwasser; Allen J Taylor Journal: Stroke Date: 2011-01-31 Impact factor: 7.914
Authors: Pierre Amarenco; Julien Bogousslavsky; Alfred Callahan; Larry B Goldstein; Michael Hennerici; Amy E Rudolph; Henrik Sillesen; Lisa Simunovic; Michael Szarek; K M A Welch; Justin A Zivin Journal: N Engl J Med Date: 2006-08-10 Impact factor: 91.245
Authors: Georgios Tsivgoulis; Ramin Zand; Aristeidis H Katsanos; Nitin Goyal; Ken Uchino; Jason Chang; Efthimios Dardiotis; Jukka Putaala; Anne W Alexandrov; Marc D Malkoff; Andrei V Alexandrov Journal: Stroke Date: 2015-03-19 Impact factor: 7.914
Authors: Alexander C Flint; Hooman Kamel; Babak B Navi; Vivek A Rao; Bonnie S Faigeles; Carol Conell; Jeff G Klingman; Stephen Sidney; Nancy K Hills; Michael Sorel; Sean P Cullen; S Claiborne Johnston Journal: Stroke Date: 2011-10-20 Impact factor: 7.914
Authors: J Montaner; P Chacón; J Krupinski; F Rubio; M Millán; C A Molina; P Hereu; M Quintana; J Alvarez-Sabín Journal: Eur J Neurol Date: 2007-12-07 Impact factor: 6.089
Authors: G Tsivgoulis; C Krogias; G S Georgiadis; R Mikulik; A Safouris; S H Meves; K Voumvourakis; M Haršány; R Staffa; S G Papageorgiou; A H Katsanos; A Lazaris; A Mumme; M Lazarides; S N Vasdekis Journal: Eur J Neurol Date: 2014-05-17 Impact factor: 6.089
Authors: Georgios Tsivgoulis; Aristeidis H Katsanos; Pavla Kadlecová; Anna Czlonkowska; Adam Kobayashi; Miroslav Brozman; Viktor Švigelj; Laszlo Csiba; Klara Fekete; Janika Kõrv; Vida Demarin; Aleksandras Vilionskis; Dalius Jatuzis; Yakup Krespi; Chrissoula Liantinioti; Sotirios Giannopoulos; Robert Mikulik Journal: J Neurol Date: 2017-03-18 Impact factor: 4.849
Authors: Georgios Tsivgoulis; Aristeidis H Katsanos; Dimitris Mavridis; Anne W Alexandrov; Georgios Magoufis; Adam Arthur; Valeria Caso; Peter D Schellinger; Andrei V Alexandrov Journal: Ther Adv Neurol Disord Date: 2016-12-01 Impact factor: 6.570
Authors: Nitin Goyal; Georgios Tsivgoulis; Konark Malhotra; Alexander L Houck; Yasser M Khorchid; Abhi Pandhi; Violiza Inoa; Khalid Alsherbini; Andrei V Alexandrov; Adam S Arthur; Lucas Elijovich; Jason J Chang Journal: J Am Heart Assoc Date: 2018-04-13 Impact factor: 5.501