Background & Purpose: Statin pretreatment is associated with better functional outcomes and lower risk of mortality in acute ischemic stroke (AIS). We hypothesized that this association may be accentuated in AIS due to large-artery atherosclerosis (LAA) that carries the highest risk of early stroke recurrence.
Methods: Consecutive patients with acute LAA were prospectively evaluated from seven tertiary-care stroke centers during a three-year period. Statin pretreatment, demographics, vascular risk factors, admission and discharge NIHSS-scores were recorded. The outcome events of interest were neurological improvement during hospitalization (quantified as the relative decrease in NIHSS-score at discharge in comparison to hospital admission), favorable functional outcome (FFO, defined as mRS-score of 0-1), recurrent stroke and death at 1-month. Statistical analyses were performed using univariate and multivariate Cox regression models adjusting for potential confounders. All analyses were repeated following propensity score matching.
Results: Statin pretreatment was documented in 192 (37.2%) out of 516 consecutive LAA patients (mean age: 65±13 years; 60.8% men; median NIHSS-score: 9 points, interquartile range: 5-18). Neurological improvement during hospitalization was greater in patients with than without statin pretreatment in unmatched and matched analyses (66.7% vs. 34.8%; p<0.001). Statin pretreatement was associated higher rates of 30-day FFO in unmatched and matched (OR for FFO: 0.48; 95%CI: 0.31-0.75) analyses. Statin pretreatment was related to lower risk of 1-month mortality and stroke recurrence in unmatched and matched analyses (HR for recurrent stroke: 0.11; 95%CI: 0.02-0.46, HR for death: 0.24, 95%CI: 0.08-0.75).
Conclusions: Statin pretreatment in patients with acute LAA appears to be associated with better early outcomes in terms of neurological improvement, disability, survival and stroke recurrence.