급성기 뇌경색 환자에서 Staitn 처방과 임상결과 지표 분석
Patterns of Statin Treatments During Acute Stroke Period and Clinical Outcomes in Patients with Ischemic Stroke
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Background : Generally speaking, the condition of dyslipidemia is a major risk factor for the development of an ischemic stroke. The domestic and international stroke guidelines recommend that physicians follow the 2004 NCEP-ATP III and 2013 ACC/AHA dyslipidemia treatment guidelines when using statins for the prevention of an ischemic stroke. However, the role of statin therapy in the patients with acute cerebral infarction has not been established, and is generally prescribed under clinical judgment. The purpose of this study was to evaluate the status and appropriateness of the statin treatment for patients with an acute cerebral infarction in the emergency department. Methods : In this study, we analyzed 430 patients who were diagnosed with an ischemic stroke at the Seoul National University Hospital from July 2013 to May 2015. We retrospectively analyzed the prescription pattern of statin therapy for the first 72 hours and 3 months, after the admission due to an ischemic stroke with a review of the patient electronic medical records. We also evaluated the effects of statin use during an acute phase of ischemic stroke on the patient clinical outcomes. Results : Among the 430 patients who participated in the study, there were 314 patients (73.0%) who received a statin within 72 hours after admission, and 246 patients (78.3%) who were prescribed with moderate intensity statins. The predictors of statin therapy within 72 hours after hospital admission were patients who had received previous statin use (aOR 7.38, 95% CI 3.77-14.44), LDL 100 mg/dL on admission (aOR 8.98, 95% CI 4.99-16.19), and who had experienced large artery atherosclerosis (aOR 2.92, 95% CI 1.64-5.22) type by TOAST classification. In addition, the high-intensity statin was less prescribed in a stroke of cardioembolism (aOR 0.33, 95% CI 0.12-0.90), and a small vessel occlusion (aOR 0.28, 95% CI 0.11-0.70), as compared with a large artery atherosclerosis. The compliance with the 2013 ACC/AHA guideline on the treatment of hyperlipidemia was 34.1% in this case. The use of statin within 72 hours after admission did not affect each clinical outcome, which included early neurological deterioration for 7 days, mRS 2 at 3 months and a recurrent ischemic stroke within 3 months after admission. Conclusion : The main factors influencing the prescription status and clinical outcome were a previous medication, LDL level, and the pathogenesis of a stroke. The effect of the statin on the clinical outcome in an acute cerebral infarction should be confirmed by a prospective study of stroke patients with the same pathogenesis.
Abstract
Background : Generally speaking, the condition of dyslipidemia is a major risk factor for the development of an ischemic stroke. The domestic and international stroke guidelines recommend that physicians follow the 2004 NCEP-ATP III and 2013 ACC/AHA dyslipidemia treatment guidelines when using statins for the prevention of an ischemic stroke. However, the role of statin therapy in the patients with acute cerebral infarction has not been established, and is generally prescribed under clinical judgment. The purpose of this study was to evaluate the status and appropriateness of the statin treatment for patients with an acute cerebral infarction in the emergency department. Methods : In this study, we analyzed 430 patients who were diagnosed with an ischemic stroke at the Seoul National University Hospital from July 2013 to May 2015. We retrospectively analyzed the prescription pattern of statin therapy for the first 72 hours and 3 months, after the admission due to an ischemic stroke with a review of the patient electronic medical records. We also evaluated the effects of statin use during an acute phase of ischemic stroke on the patient clinical outcomes. Results : Among the 430 patients who participated in the study, there were 314 patients (73.0%) who received a statin within 72 hours after admission, and 246 patients (78.3%) who were prescribed with moderate intensity statins. The predictors of statin therapy within 72 hours after hospital admission were patients who had received previous statin use (aOR 7.38, 95% CI 3.77-14.44), LDL 100 mg/dL on admission (aOR 8.98, 95% CI 4.99-16.19), and who had experienced large artery atherosclerosis (aOR 2.92, 95% CI 1.64-5.22) type by TOAST classification. In addition, the high-intensity statin was less prescribed in a stroke of cardioembolism (aOR 0.33, 95% CI 0.12-0.90), and a small vessel occlusion (aOR 0.28, 95% CI 0.11-0.70), as compared with a large artery atherosclerosis. The compliance with the 2013 ACC/AHA guideline on the treatment of hyperlipidemia was 34.1% in this case. The use of statin within 72 hours after admission did not affect each clinical outcome, which included early neurological deterioration for 7 days, mRS 2 at 3 months and a recurrent ischemic stroke within 3 months after admission. Conclusion : The main factors influencing the prescription status and clinical outcome were a previous medication, LDL level, and the pathogenesis of a stroke. The effect of the statin on the clinical outcome in an acute cerebral infarction should be confirmed by a prospective study of stroke patients with the same pathogenesis.
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