Dataset Information

Impact of High-Intensity Statin on Early Neurologic Deterioration in Patients with Single Small Subcortical Infarction.

ABSTRACT:

Backgrounds

One of the major hypotheses for early neurological deterioration (END) in single small subcortical infarction (SSSI) is the process of atherosclerosis. However, the association between statin therapy, especially high-intensity statin therapy, and its effectiveness in reducing the incidence of END during the acute phase of SSSI remains unclear. This study aimed to investigate the influence of high-intensity statin therapy compared to moderate-intensity statin therapy during the acute phase on the incidence of END in SSSI.

Methods

The records of 492 patients with SSSI who received statin therapy within 72 h of symptom onset from a prospective stroke registry were analyzed. The association between END and statin intensity was evaluated using multivariable regression analysis for adjusted odds ratio (aOR).

Results

Of the 492 patients with SSSI (mean age: 67.2 years, median NIHSS score on admission: 3), END occurred in 102 (20.7%). Older age (aOR, 1.02; 95% confidence interval (CI), 1.00-1.05; p = 0.017), and branch atheromatous lesion (aOR, 3.49; 95% CI 2.16-5.74; p < 0.001) were associated with END. Early high-intensity statin therapy was associated with a lower incidence of END than moderate-intensity statin therapy (aOR, 0.44; 95% CI, 0.25-0.77; p = 0.004). In addition, there was significantly lower incidence of END in early administration (≤24 h) of high-intensity statin group.

Conclusions

We identified an association between the intensity of early statin therapy and END in patients with SSSI. Early administration of high-intensity statin (≤24 h) is associated with a reduced incidence of END in patients with SSSI.

SUBMITTER: Jang SH

PROVIDER: S-EPMC10179331 | biostudies-literature | 2023 May

REPOSITORIES: biostudies-literature

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Publications

Impact of High-Intensity Statin on Early Neurologic Deterioration in Patients with Single Small Subcortical Infarction.

Jang Seong Hwa SH Park Hyungjong H Hong Jeong-Ho JH Yoo Joonsang J Lee Hyung H Kim Hyun Ah HA Sohn Sung-Il SI

Journal of clinical medicine 20230503 9

<h4>Backgrounds</h4>One of the major hypotheses for early neurological deterioration (END) in single small subcortical infarction (SSSI) is the process of atherosclerosis. However, the association between statin therapy, especially high-intensity statin therapy, and its effectiveness in reducing the incidence of END during the acute phase of SSSI remains unclear. This study aimed to investigate the influence of high-intensity statin therapy compared to moderate-intensity statin therapy during th ...[more]

PMID: 37176701

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Project description:IntroductionThis study aims to evaluate the clinical and imaging risk factors for early neurological deterioration (END) and long-term neurological disability in patients with Single subcortical small infarction (SSSI).MethodsWe retrospectively included SSSI patients hospitalized. Outcomes were defined as modified Rankin Scale (mRS) score > 2 at follow-up and the occurrence of END during hospitalization. Multivariate logistic regression identified independent predictors of END and long-term outcomes. Stepwise regression analysis was used to develop a predictive model for poor outcomes. The predictive performance of risk factors and the model was assessed using receiver operating characteristic (ROC) curves.ResultsA total of 289 SSSI patients were included. During hospitalization, 18 patients (6.2%) experienced END, and 29 patients (10%) had neurological disability at a median follow-up of 21.4 (16.7-25.2) months. Multivariate analysis showed the National Institutes of Health Stroke Scale (NIHSS) score(OR 1.43, 95% CI 1.19-1.73, P < 0.001), and neutrophil to high-density lipoprotein cholesterol ratio (NHR) (OR 1.28, 95% CI 1.02-1.60, P = 0.034) were independently associated with END. Age (OR 1.08, 95% CI 1.01-1.15, P = 0.028), NIHSS (OR 1.60, 95% CI 1.29-1.98, P < 0.001), symptomatic intracranial artery stenosis (OR 5.26, 95% CI 1.56-17.71, P = 0.007), lacune number (OR 1.51, 95% CI 1.13-2.04, P = 0.006), the degree of brain atrophy (OR 2.03, 95% CI 1.19-3.46, P = 0.01), and mean hemoglobin concentration (MCHC) (OR 0.96, 95% CI 0.92-0.99, P = 0.04) were independently associated with neurological disability. The predictive model for END (included NIHSS score and NHR level) and long-term neurological disability (included age, NIHSS score, symptomatic intracranial artery stenosis, number of lacunes, and brain atrophy) showed areas under the ROC curve of 0.836 and 0.926, respectively.ConclusionHigh NIHSS and NHR are independent risk factors for END. Age, NIHSS, symptomatic intracranial artery stenosis, the number of lacunes, and brain atrophy are predictors of neurological disability in SSSI patients.

Project description:ObjectiveFactors that predict poor outcomes in patients with single subcortical infarction (SSI) may differ from those that predict poor outcomes in the SSI subgroup with neurological deterioration (ND). This study aimed to investigate the effect of ND on functional outcomes in patients with SSI and the clinical factors that predict poor outcomes in patients with SSI with ND (SSI-ND) and in all patients with SSI.MethodsPatients with SSI were consecutively enrolled in this study. ND was defined as an increase of ≥2 points in the National Institutes of Health Stroke Scale (NIHSS) total score, an increase of ≥1 point in the NIHSS subscore of consciousness or motor function, or any new neurological deficit.ResultsA total of 255 patients were enrolled, and nine (3.53%) were lost to a follow-up. ND [adjusted relative risk (aRR) = 1.37, 95% confidence interval (CI) = 1.22-1.55, p < 0.001], female sex (aRR = 1.13, 95% CI = 1.03-1.24, p = 0.12), initial NIHSS (aRR = 1.08, 95% CI = 1.07-1.10, p < 0.001), and parental arterial disease (PAD) (aRR = 1.16, 95% CI = 1.07-1.26, p = 0.038) were associated with a poor 90-day outcome (the modified Rankin scale (mRS) > 2 points) in patients with SSI. In the SSI-ND subgroup, PAD (aRR = 2.15, 95% CI = 1.20-3.86, p = 0.01), glycosylated hemoglobin (aRR = 1.17, 95% CI = 1.01-1.35, p = 0.035), and severe NIHSS (aRR = 1.15, 95% CI = 1.06-1.25, p = 0.001) were predictive of a poor outcome, and PAD (aRR = 1.87, 95% CI = 1.19-2.95, p = 0.007) was correlated with higher/worsened NIHSS [> 2 points (median)]. For predicting poor outcomes in patients with SSI-ND with PAD, a more severe NIHSS (aRR = 1.09, 95% CI = 1.02-1.17, p = 0.01) was the only determinant, with a cutoff of 4.5 points, a sensitivity of 94.0%, and a specificity of 83.3%.ConclusionsND is an independent predictor of poor outcomes in patients with SSI, and poor outcome determinants in the SSI-ND subgroup and in all patients with SSI are not identical. For patients with SSI-ND, PAD could aggravate ND and was therefore an essential predictor of poor outcomes.

Dataset Information

Impact of High-Intensity Statin on Early Neurologic Deterioration in Patients with Single Small Subcortical Infarction.

Backgrounds

Methods

Results

Conclusions

Publications

Impact of High-Intensity Statin on Early Neurologic Deterioration in Patients with Single Small Subcortical Infarction.

Similar Datasets

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