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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.

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journal contribution
posted on 21.05.2018, 14:06 by J. S. Minhas, X. Wang, H. Arima, P. M. Bath, L. Billot, J. P. Broderick, G. A. Donnan, J. S. Kim, P. M. Lavados, T-H. Lee, S. C. O. Martins, V. V. Olavarría, J. D. Pandian, O. M. Pontes-Neto, S. Ricci, S. Sato, V. K. Sharma, N. H. Thang, J-G. Wang, M. Woodward, J. Chalmers, C. S. Anderson, T. G. Robinson, ENCHANTED Investigators
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.

Funding

The study is supported by grants from the National Health and Medical Research Council (NHMRC) of Australia, the Stroke Association of the United Kingdom, the Ministry of Health and the National Council for Scientific and Technological Development of Brazil (CNPQ: 467322/2014-7, 402388/2013-5), and the Ministry for Health, Welfare and Family Affairs of the Republic of Korea (HI14C1985).

History

Citation

Cerebrovascular Diseases, 2018, 45 (5-6), pp. 213-220

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Cardiovascular Sciences

Version

AM (Accepted Manuscript)

Published in

Cerebrovascular Diseases

Publisher

Karger Publishers

issn

1015-9770

eissn

1421-9786

Acceptance date

31/03/2018

Copyright date

2018

Available date

21/05/2018

Publisher version

https://www.karger.com/Article/FullText/488911

Language

en