Abstract TMP4: Early Statin Intervention Can Reduce Progression in Acute Lacunar Stroke -An Analysis Using Propensity Score

Abstract

Background and Purpose: Some patients with lacunar infarction show clinical neurological deterioration within few days after the onset. Otherwise, it is presumed that statins might prevent progression in acute lacunar stroke by its beneficial pleiotropic effects. We investigated whether early statin intervention (ESI) can reduce the early neurological deterioration and recurrence in acute lacunar stroke . Methods: We retrospectively studied 345 consecutive patients (217 men; mean age, 72 years) with a lacunar infarction admitted within 72 hours after the onset between Jan 2011 and Dec 2013 in our center. Of these, 151 patients (43.8 %) were treated with ESI (ESI group), defined as newly initiated statin (138 patients), dose-escalation of pre-treated statin (3 patients) or switching to strong statin (10 patients) within 72 hours after the onset. Progressive infarction (PI) was defined as an increase of ≥ 4 points in the NIHSS score or recurrence of symptomatic ischemic stroke within 30 days after the onset. Inverse probability of treatment weighting (IPTW) and propensity score-matching analysis were performed due to assess the association between ESI and PI. Results: Thirty-one patients (9.0%) had PI, 28 (8.1%) with neurological deterioration and 3 (1.0%) with symptomatic recurrence. PI of 10 patients (6.6 %) occurred in the ESI group and 21 patients (10.8%) in the non-ESI group (P = 0.18). Multivariable analysis showed that ESI was inversely related to PI (OR: 0.32; 95% CI: 0.12-0.81, P=0.02]. After adjustment with IPTW, PI was significantly less in the ESI group than non-ESI group [OR: 0.26; 95% CI: 0.10-0.68, P<0.01]. Propensity score matching yielded a well-balanced cohort of 182 patients (91 pairs with and without ESI). In this population, ESI was inversely associated with PI [OR: 0.36; 95% CI: 0.13-0.99, P=0.048]. Additionally, propensity score-matching analysis in the patient who had not received statin prior to admission (244 patients), newly initiated statin treatment was inversely related to PI [OR: 0.13; 95% CI: 0.02-1.00, P = 0.049]. Conclusion: ESI was related to reduction in early neurological deterioration and recurrence in acute lacunar stroke.