Statin Pretreatment Associated With Reduced Infarct Volume in Ischemic Stroke

In patients with atherosclerotic acute ischemic stroke, statin pretreatment (SP) is associated with reductions in final infarct volume (FIV), according to a meta-analysis published in Atherosclerosis.

Researchers identified observational studies that reported associations between SP before hospital admission with collateral circulation and FIV in patients with acute ischemic stroke. A total of 9 studies comprising 1186 patients were included.

For all analyses, a random-effects model was used. The investigators pooled both odds ratios (OR) and standardized mean differences (SMDs) on the collateral status and FIV based on SP history.

On neuroimaging, a history of SP was associated with reduced FIV compared with no SP (SMD, 0.25; 95% CI, 0.07-0.42; P =.005). There was a trend toward good collateral scores in patients who had received SP (OR, 1.45; 95% CI, 0.92-2.29; P =.11). In 3 studies, SP was associated with reduced FIV among patients with atherosclerotic strokes (SMD, 0.49; 95% CI, 0.19-0.80; P =.001).

There was no observable heterogeneity in the subanalysis (I² = 0%; P for Cochran Q statistic =0.51), nor was there evidence for heterogeneity for FIV (I² = 12%; P for Cochran Q statistic =0.34) or good collateral status (I² = 34%; P for Cochran Q statistic =0.17).

Limitations of the analysis were the inclusion of mostly small observational cohorts, as well as the lack of data on FIV and collateral scores in the majority of the included studies.

The beneficial effects of SP in patients with acute ischemic stroke “are likely attributed to the potential for statins to promote arteriogenesis and augment the [endothelial nitric oxide synthase]-mediated vasodilation,” explained the researchers.

Reference

Malhotra K, Safouris A, Goyal N, et al. Association of statin pretreatment with collateral circulation and final infarct volume in acute ischemic stroke patients: a meta-analysis. Atherosclerosis. 2019;282:75-79.