Abstract 3799: Baseline Total Cholesterol Levels and Risk of Developing Brain Edema after Intravenous Thrombolysis in Acute Ischemic Stroke Patients

Abstract

Objectives: There is evidence that low plasma cholesterol levels(CLs) are among the factors that contribute to blood brain barrier disruption in acute ischemic stroke, leading to hemorrhagic transformation.The aim of this was to evaluate the association between baseline CLs and the development of brain edema (BE)after i.v. thrombolysis in AIS. Methods: We analyzed all the data of AIS patients treated with i.v. rt-PA in Italy from 2003 to 2009 included in the international internet-based SITS-ISTR.The presence and severity of the BE was assessed on 22-36 hour and 7-day neuroimaging as mild, moderate and severe.Total CLs were obtained within 24 hours from symptom onset.Univariate and multivariate analyses were performed. Results: Overall, 4194 patients were included,of which 2577/4194 (61.4%) had data on baseline CLs.We analyzed CLs based on quartiles:≤164 mg/dl,≤191 mg/dl,≤221 mg/dl and >221 mg/dl. 1126/3782 (29.8%) developed BE within 22-36 hours of symptom onset,397 of 1015 (39.1%) at 7 days. In 103 cases (25.9%)BE developed between 36 hours and 7 days.Of 1126 patients with both 22-36 hour and 7-day neuroimaging, 89 (7.9%)had a BE worsening and 21 (1.9%)an improvement.Compared to those without BE,patients with BE were more likely to be dependent before stroke (p=0.031),have AF (p<0.0001),have early ischemic signs on baseline CT,higher prevalence of cardioembolic and large vessel mechanism,more SICH per NINDS definition,(p<0.0001).BE+ subjects had higher baseline median NIHSS(17 vs 11,p<0.0001), blood glucose levels (BGLs)(p=0.001) and DBP(p=0.044).Patients with BE had a worse outcome in terms of 3-month mRS>2 (72.5 vs 35.3%) and death (25.8 vs 6.7%) (p<0.0001).Subjects with BE were less likely to have a history of dyslipidemia (p=0.009).Independent predictors of BE developing within 22-36 hours were baseline NIHSS(OR1.104,95%CI 1.085-1.124,p<0.0001), BGLs(OR1.003,95%CI 1.001-1.005, p=0.014), onset-to-door time interval (OR1.002,95%CI 1.000-1.005,p=0.017), early ischemic signs on baseline CT (OR1.797,95%CI 1.127-2.867,p 0.014).NIHSS was confirmed as the strongest independent predictor for the presence of BE at the 7-day neuroimaging and for moderate and severe BE. BGLs was the only independent predictor of BE worsening (OR1.007,95%CI 1.000-1.014,p=0.05).Lower baseline CLs, in particular values <164 mg/dl,were independent predictors of BE improvement (OR3.758,95%IC 1.299-10.869,p=0.015)whereas higher values (>221 mg/dl) were independent predictors of severe BE at the 7-day neuroimaging (OR2.020,95%CI 1.044-3.94,p=0.037). Conclusions: Our study did not show an independent association between lower baseline total CLs and the risk of BE developing after i.v. thrombolysis in AIS. More studies are necessary to address this issue, particularly considering also the LDL-CLs and the use of statins at stroke onset and during the hospital stay.