Jonguk Kim, Uichan Hong, Cindy W. Yoon, Jin Woo Bae, Joung-Ho Rha, H. Park
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Secondary outcomes included early neurologic deterioration (END), symptomatic intracerebral hemorrhage (sICH), 3-month functional outcomes, 3-month recurrence rate, and lipid profiles.Of 261 patients (mean age 69.2 ± 11.7, men 42.9%), 42 were administered evolocumab peri-procedurally. While baseline characteristics were similar between the two groups, evolocumab group demonstrated improved discharge outcomes, with a lower mean NIHSS (8.8 ± 6.8 vs. 12.4 ± 9.8, p = 0.02) and a higher percentage of patients with discharge mRS ≤ 3 (52.4% vs. 35.6%, p = 0.041). The 3-month follow-up show a non-significant trend toward an improved outcome in the evolocumab group. Multivariable analysis indicated that evolocumab had a potential impact on favorable discharge outcomes (aOR 1.98[0.94–4.22] for mRS ≤ 3 and 0.47[0.27–0.84] for lower ordinal mRS). Notably, evolocuamb users exhibited fewer instances of END and sICH, although they do not reach statistical significance. Additionally, the evolocumab group demonstrated potential benefits in LDL cholesterol reduction over time.Early use of evolocumab in AIS patients undergoing MT appeared to be safe and associated with better early functional outcomes. The potential benefit of the PCSK9 inhibitor shown here warrants further prospective studies.","PeriodicalId":503840,"journal":{"name":"Frontiers in Neurology","volume":"110 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"PCSK9 inhibitor in acute ischemic stroke patient receiving mechanical thrombectomy: early outcomes and safety\",\"authors\":\"Jonguk Kim, Uichan Hong, Cindy W. Yoon, Jin Woo Bae, Joung-Ho Rha, H. 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Secondary outcomes included early neurologic deterioration (END), symptomatic intracerebral hemorrhage (sICH), 3-month functional outcomes, 3-month recurrence rate, and lipid profiles.Of 261 patients (mean age 69.2 ± 11.7, men 42.9%), 42 were administered evolocumab peri-procedurally. While baseline characteristics were similar between the two groups, evolocumab group demonstrated improved discharge outcomes, with a lower mean NIHSS (8.8 ± 6.8 vs. 12.4 ± 9.8, p = 0.02) and a higher percentage of patients with discharge mRS ≤ 3 (52.4% vs. 35.6%, p = 0.041). The 3-month follow-up show a non-significant trend toward an improved outcome in the evolocumab group. Multivariable analysis indicated that evolocumab had a potential impact on favorable discharge outcomes (aOR 1.98[0.94–4.22] for mRS ≤ 3 and 0.47[0.27–0.84] for lower ordinal mRS). Notably, evolocuamb users exhibited fewer instances of END and sICH, although they do not reach statistical significance. 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引用次数: 0
摘要
降脂疗法是减少急性缺血性中风(AIS)后复发的主要手段。Evolocumab 是一种 Proprotein convertase subtilisin-kexin type 9 (PCSK9) 抑制剂,是一种很有前景的降脂药,可降低低密度脂蛋白胆固醇,与他汀类药物一起缓解血管事件。然而,它对机械性血栓切除术(MT)后早期功能结果的影响仍不清楚。本研究旨在评估在接受MT的AIS患者中早期、标签外使用PCSK9抑制剂后的短期效果和出血事件发生率。我们回顾性分析了2018年12月至2023年4月在区域卒中中心接受MT的患者。我们的主要结果是出院功能预后。次要结局包括早期神经功能恶化(END)、症状性脑出血(sICH)、3个月功能结局、3个月复发率和血脂概况。在261名患者(平均年龄为69.2±11.7岁,男性占42.9%)中,42名患者在术前使用了evolocumab。虽然两组患者的基线特征相似,但 evolocumab 组的出院预后更好,平均 NIHSS 更低(8.8 ± 6.8 vs. 12.4 ± 9.8,p = 0.02),出院时 mRS ≤ 3 的患者比例更高(52.4% vs. 35.6%,p = 0.041)。3个月的随访结果显示,evolocumab组的预后改善趋势并不显著。多变量分析表明,evolocumab 对出院预后有潜在影响(mRS ≤ 3 的 aOR 为 1.98[0.94-4.22],mRS 较低序数的 aOR 为 0.47[0.27-0.84])。值得注意的是,使用 evolocuamb 的患者发生 END 和 sICH 的情况较少,但未达到统计学意义。此外,随着时间的推移,evolocumab组在降低低密度脂蛋白胆固醇方面显示出潜在的益处。在接受MT治疗的AIS患者中早期使用evolocumab似乎是安全的,并且与更好的早期功能预后相关。本文显示的 PCSK9 抑制剂的潜在益处值得进一步开展前瞻性研究。
PCSK9 inhibitor in acute ischemic stroke patient receiving mechanical thrombectomy: early outcomes and safety
Lipid-lowering therapies are mainstays in reducing recurrence after acute ischemic stroke (AIS). Evolocumab, a Proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor, is a promising lipid-lowering agent known to decrease LDL cholesterol and mitigate vascular events alongside statins. However, its effects on the early functional outcomes post-mechanical thrombectomy (MT) remain unclear. This study aimed to assess the short-term effects and incidence of bleeding events after the early, off-label use of PCSK9 inhibitors in AIS patients undergoing MT.We retrospectively analyzed patients who had MT at a Regional Stroke Center from December 2018 to April 2023. Our primary outcome was discharge functional outcomes. Secondary outcomes included early neurologic deterioration (END), symptomatic intracerebral hemorrhage (sICH), 3-month functional outcomes, 3-month recurrence rate, and lipid profiles.Of 261 patients (mean age 69.2 ± 11.7, men 42.9%), 42 were administered evolocumab peri-procedurally. While baseline characteristics were similar between the two groups, evolocumab group demonstrated improved discharge outcomes, with a lower mean NIHSS (8.8 ± 6.8 vs. 12.4 ± 9.8, p = 0.02) and a higher percentage of patients with discharge mRS ≤ 3 (52.4% vs. 35.6%, p = 0.041). The 3-month follow-up show a non-significant trend toward an improved outcome in the evolocumab group. Multivariable analysis indicated that evolocumab had a potential impact on favorable discharge outcomes (aOR 1.98[0.94–4.22] for mRS ≤ 3 and 0.47[0.27–0.84] for lower ordinal mRS). Notably, evolocuamb users exhibited fewer instances of END and sICH, although they do not reach statistical significance. Additionally, the evolocumab group demonstrated potential benefits in LDL cholesterol reduction over time.Early use of evolocumab in AIS patients undergoing MT appeared to be safe and associated with better early functional outcomes. The potential benefit of the PCSK9 inhibitor shown here warrants further prospective studies.