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
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 pretrea...
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Karger Publishers
2018
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| Online Access: | https://eprints.nottingham.ac.uk/51567/ |
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| author | 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. |
| author_facet | 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. |
| author_sort | Minhas, Jatinder S. |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | 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. |
| first_indexed | 2025-11-14T20:21:09Z |
| format | Article |
| id | nottingham-51567 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T20:21:09Z |
| publishDate | 2018 |
| publisher | Karger Publishers |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-515672020-05-04T19:34:02Z https://eprints.nottingham.ac.uk/51567/ 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. 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. Karger Publishers 2018-04-27 Article PeerReviewed 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 Lipid-lowering therapy; Statins; Stroke; Intracranial haemorrhage; Risk factors; Acute stroke outcome https://www.karger.com/Article/Abstract/488911 doi:10.1159/000488911 doi:10.1159/000488911 |
| spellingShingle | Lipid-lowering therapy; Statins; Stroke; Intracranial haemorrhage; Risk factors; Acute stroke outcome 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. 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 |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Lipid-lowering therapy; Statins; Stroke; Intracranial haemorrhage; Risk factors; Acute stroke outcome |
| url | https://eprints.nottingham.ac.uk/51567/ https://eprints.nottingham.ac.uk/51567/ https://eprints.nottingham.ac.uk/51567/ |