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KOR

Statins in Acute Ischemic Stroke: A Systematic Review
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논문 기본 정보

Type
Academic journal
Author
Journal
The Korean Stroke Society 대한뇌졸중학회지 대한뇌졸중학회지 제17권 제3호 KCI Accredited Journals
Published
2015.1
Pages
282 - 301 (20page)

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Statins in Acute Ischemic Stroke: A Systematic Review
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Background and Purpose Statins have pleiotropic effects of potential neuroprotection. However, because of lack of large randomized clinical trials, current guidelines do not provide specific recommendations on statin initiation in acute ischemic stroke (AIS). The current study aims to systematically review the statin effect in AIS. Methods From literature review, we identified articles exploring prestroke and immediate post-stroke statin effect on imaging surrogate markers, initial stroke severity, functional outcome, and short-term mortality in human AIS. We summarized descriptive overview. In addition, for subjects with available data from publications, we conducted meta-analysis to provide pooled estimates. Results In total, we identified 70 relevant articles including 6 meta-analyses. Surrogate imaging marker studies suggested that statin might enhance collaterals and reperfusion. Our updated meta-analysis indicated that prestroke statin use was associated with milder initial stroke severity (odds ratio [OR] [95% confidence interval], 1.24 [1.05-1.48]; P=0.013), good functional outcome (1.50 [1.29-1.75]; P<0.001), and lower mortality (0.42 [0.21-0.82]; P=0.0108). In-hospital statin use was associated with good functional outcome (1.31 [1.12-1.53]; P=0.001), and lower mortality (0.41 [0.29-0.58]; P<0.001). In contrast, statin withdrawal was associated with poor functional outcome (1.83 [1.01-3.30]; P=0.045). In patients treated with thrombolysis, statin was associated with good functional outcome (1.44 [1.10-1.89]; P=0.001), despite an increased risk of symptomatic hemorrhagic transformation (1.63 [1.04-2.56]; P=0.035). Conclusions The current study findings support the use of statin in AIS. However, the findings were mostly driven by observational studies at risk of bias, and thereby large randomized clinical trials would provide confirmatory evidence.
#Statins #Acute ischemic stroke #Stroke severity #Outcome #Mortality #Symptomatic hemorrhagic transformation

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Higgins JPT / 2008 / Cochrane Handbook for Systematic Reviews of Interventions / Cochrane Collaboration and John Wiley & Sons Ltd google schola Shook SJ / 2006 / Statin use is independently associated with smaller infarct volume in nonlacunar MCA territory stroke / J Neuroimaging 16:341~346 google schola Ovbiagele B / 2007 / Statin enhancement of collateralization in acute stroke / Neurology 68:2129~2131 google schola Nicholas JS / 2008 / The effect of statin pretreatment on infarct volume in ischemic stroke / Neuroepidemiology 31:48~56 google schola Ford AL / 2011 / Preexisting statin use is associated with greater reperfusion in hyperacute ischemic stroke / Stroke 42:1307~1313 google schola

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