Sylvia E Choi, Tommaso Bucci, Jia-Yi Huang, Kai-Hang Yiu, Christopher Tw Tsang, Kui Kai Lau, Andrew Hill, Greg Irving, Gregory Yh Lip, Azmil H Abdul-Rahim
{"title":"早期使用他汀类药物与改善心房颤动和近期缺血性中风患者的生存率和心血管预后有关:对全球联合健康数据库的倾向匹配分析。","authors":"Sylvia E Choi, Tommaso Bucci, Jia-Yi Huang, Kai-Hang Yiu, Christopher Tw Tsang, Kui Kai Lau, Andrew Hill, Greg Irving, Gregory Yh Lip, Azmil H Abdul-Rahim","doi":"10.1177/23969873241274213","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Statins reduce recurrent stroke and cardiovascular events in patients with non-cardioembolic stroke. The benefits of statins in patients with AF and recent IS remain unclear. We aimed to investigate the benefits of statins in patients with AF and recent IS.</p><p><strong>Patients and methods: </strong>This retrospective, cohort study was conducted using deidentified electronic medical records within TriNetX platform. Patients with AF and recent IS, who received statins within 28 days of their index stroke were propensity score-matched with those who did not. Patients were followed up for up to 2 years. Primary outcomes were the 2-year risk of recurrent IS, all-cause mortality and the composite outcome of all-cause mortality, recurrent IS, transient ischaemic attack (TIA), and acute myocardial infarction (MI). Secondary outcomes were the 2-year risk of TIA, intracranial haemorrhage (ICH), acute MI, and hospital readmission. Cox regression analyses were used to calculate hazard ratios (HRs) with 95% confidence intervals (95%CI).</p><p><strong>Results: </strong>Of 20,902 patients with AF and recent IS, 7500 (35.9%) received statins within 28 days of their stroke and 13,402 (64.1%) did not. 11,182 patients (mean age 73.7 ± 11.5; 5277 (47.2%) female) remained after propensity score matching. Patients who received early statins had significantly lower risk of recurrent IS (HR: 0.45, 95%CI: 0.41-0.48, <i>p</i> < 0.001), mortality (HR: 0.75, 95%CI: 0.66-0.84, <i>p</i> < 0.001), the composite outcome (HR: 0.48, 95%CI: 0.45-0.52, <i>p</i> < 0.001), TIA (HR: 0.37, 95%CI: 0.30-0.44, <i>p</i> < 0.001), ICH (HR: 0.59, 95%CI: 0.47-0.72, <i>p</i> < 0.001 ), acute MI (HR: 0.35, 95%CI: 0.30-0.42, <i>p</i> < 0.001) and hospital readmission (HR: 0.46, 95%CI: 0.42-0.50, <0.001). Beneficial effects of early statins were evident in the elderly, different ethnic groups, statin dose intensity, and AF subtypes, large vessel occlusion and embolic strokes and within the context of statin lipophilicity, optimal LDL-cholesterol levels, various cardiovascular comorbidities, treatment with intravenous thrombolysis or endovascular thrombectomy, and NIHSS 0-5 and NIHSS > 5 subgroups.</p><p><strong>Discussion and conclusion: </strong>Patients with AF and recent IS, who received early statins, had a lower risk of recurrent stroke, death, and other cardiovascular outcomes including ICH, compared to those who did not.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8000,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Early statin use is associated with improved survival and cardiovascular outcomes in patients with atrial fibrillation and recent ischaemic stroke: A propensity-matched analysis of a global federated health database.\",\"authors\":\"Sylvia E Choi, Tommaso Bucci, Jia-Yi Huang, Kai-Hang Yiu, Christopher Tw Tsang, Kui Kai Lau, Andrew Hill, Greg Irving, Gregory Yh Lip, Azmil H Abdul-Rahim\",\"doi\":\"10.1177/23969873241274213\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Statins reduce recurrent stroke and cardiovascular events in patients with non-cardioembolic stroke. The benefits of statins in patients with AF and recent IS remain unclear. We aimed to investigate the benefits of statins in patients with AF and recent IS.</p><p><strong>Patients and methods: </strong>This retrospective, cohort study was conducted using deidentified electronic medical records within TriNetX platform. Patients with AF and recent IS, who received statins within 28 days of their index stroke were propensity score-matched with those who did not. Patients were followed up for up to 2 years. Primary outcomes were the 2-year risk of recurrent IS, all-cause mortality and the composite outcome of all-cause mortality, recurrent IS, transient ischaemic attack (TIA), and acute myocardial infarction (MI). Secondary outcomes were the 2-year risk of TIA, intracranial haemorrhage (ICH), acute MI, and hospital readmission. Cox regression analyses were used to calculate hazard ratios (HRs) with 95% confidence intervals (95%CI).</p><p><strong>Results: </strong>Of 20,902 patients with AF and recent IS, 7500 (35.9%) received statins within 28 days of their stroke and 13,402 (64.1%) did not. 11,182 patients (mean age 73.7 ± 11.5; 5277 (47.2%) female) remained after propensity score matching. Patients who received early statins had significantly lower risk of recurrent IS (HR: 0.45, 95%CI: 0.41-0.48, <i>p</i> < 0.001), mortality (HR: 0.75, 95%CI: 0.66-0.84, <i>p</i> < 0.001), the composite outcome (HR: 0.48, 95%CI: 0.45-0.52, <i>p</i> < 0.001), TIA (HR: 0.37, 95%CI: 0.30-0.44, <i>p</i> < 0.001), ICH (HR: 0.59, 95%CI: 0.47-0.72, <i>p</i> < 0.001 ), acute MI (HR: 0.35, 95%CI: 0.30-0.42, <i>p</i> < 0.001) and hospital readmission (HR: 0.46, 95%CI: 0.42-0.50, <0.001). Beneficial effects of early statins were evident in the elderly, different ethnic groups, statin dose intensity, and AF subtypes, large vessel occlusion and embolic strokes and within the context of statin lipophilicity, optimal LDL-cholesterol levels, various cardiovascular comorbidities, treatment with intravenous thrombolysis or endovascular thrombectomy, and NIHSS 0-5 and NIHSS > 5 subgroups.</p><p><strong>Discussion and conclusion: </strong>Patients with AF and recent IS, who received early statins, had a lower risk of recurrent stroke, death, and other cardiovascular outcomes including ICH, compared to those who did not.</p>\",\"PeriodicalId\":46821,\"journal\":{\"name\":\"European Stroke Journal\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":5.8000,\"publicationDate\":\"2024-09-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Stroke Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/23969873241274213\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Stroke Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/23969873241274213","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
简介:他汀类药物可减少非心血管栓塞性中风患者的复发性中风和心血管事件。他汀类药物对房颤和近期发生过 IS 的患者的益处尚不清楚。我们旨在研究他汀类药物对房颤和近期发生 IS 的患者的益处:这项回顾性队列研究使用 TriNetX 平台中的去身份化电子病历。心房颤动和近期IS患者在中风发生后28天内接受了他汀类药物治疗,并与未接受他汀类药物治疗的患者进行了倾向评分匹配。对患者进行了长达 2 年的随访。主要结果是两年内IS复发风险、全因死亡率以及全因死亡率、IS复发、短暂性脑缺血发作(TIA)和急性心肌梗死(MI)的综合结果。次要结果是 TIA、颅内出血 (ICH)、急性心肌梗死和再次入院的 2 年风险。采用 Cox 回归分析计算危险比(HRs)和 95% 置信区间(95%CI):在 20902 名房颤且近期发生过 IS 的患者中,7500 人(35.9%)在中风后 28 天内服用了他汀类药物,13402 人(64.1%)未服用。经过倾向得分匹配后,仍有 11182 名患者(平均年龄为 73.7 ± 11.5;5277 人(47.2%)为女性)接受了他汀类药物治疗。早期接受他汀类药物治疗的患者复发IS的风险明显降低(HR:0.45,95%CI:0.41-0.48,p p p p p p 5个亚组):讨论与结论:与未接受他汀类药物治疗的患者相比,接受早期他汀类药物治疗的房颤和近期IS患者发生卒中复发、死亡和其他心血管后果(包括ICH)的风险较低。
Early statin use is associated with improved survival and cardiovascular outcomes in patients with atrial fibrillation and recent ischaemic stroke: A propensity-matched analysis of a global federated health database.
Introduction: Statins reduce recurrent stroke and cardiovascular events in patients with non-cardioembolic stroke. The benefits of statins in patients with AF and recent IS remain unclear. We aimed to investigate the benefits of statins in patients with AF and recent IS.
Patients and methods: This retrospective, cohort study was conducted using deidentified electronic medical records within TriNetX platform. Patients with AF and recent IS, who received statins within 28 days of their index stroke were propensity score-matched with those who did not. Patients were followed up for up to 2 years. Primary outcomes were the 2-year risk of recurrent IS, all-cause mortality and the composite outcome of all-cause mortality, recurrent IS, transient ischaemic attack (TIA), and acute myocardial infarction (MI). Secondary outcomes were the 2-year risk of TIA, intracranial haemorrhage (ICH), acute MI, and hospital readmission. Cox regression analyses were used to calculate hazard ratios (HRs) with 95% confidence intervals (95%CI).
Results: Of 20,902 patients with AF and recent IS, 7500 (35.9%) received statins within 28 days of their stroke and 13,402 (64.1%) did not. 11,182 patients (mean age 73.7 ± 11.5; 5277 (47.2%) female) remained after propensity score matching. Patients who received early statins had significantly lower risk of recurrent IS (HR: 0.45, 95%CI: 0.41-0.48, p < 0.001), mortality (HR: 0.75, 95%CI: 0.66-0.84, p < 0.001), the composite outcome (HR: 0.48, 95%CI: 0.45-0.52, p < 0.001), TIA (HR: 0.37, 95%CI: 0.30-0.44, p < 0.001), ICH (HR: 0.59, 95%CI: 0.47-0.72, p < 0.001 ), acute MI (HR: 0.35, 95%CI: 0.30-0.42, p < 0.001) and hospital readmission (HR: 0.46, 95%CI: 0.42-0.50, <0.001). Beneficial effects of early statins were evident in the elderly, different ethnic groups, statin dose intensity, and AF subtypes, large vessel occlusion and embolic strokes and within the context of statin lipophilicity, optimal LDL-cholesterol levels, various cardiovascular comorbidities, treatment with intravenous thrombolysis or endovascular thrombectomy, and NIHSS 0-5 and NIHSS > 5 subgroups.
Discussion and conclusion: Patients with AF and recent IS, who received early statins, had a lower risk of recurrent stroke, death, and other cardiovascular outcomes including ICH, compared to those who did not.
期刊介绍:
Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.