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Statin treatment is associated with improved Statin treatment is associated with improved prognosis in patients withprognosis in patients with

AF-related strokeAF-related stroke

G. Ntaios G. Ntaios 1, V. Papavasileiou , V. Papavasileiou 1, K.Makaritsis , K.Makaritsis 1,, A.Karagiannaki A.Karagiannaki 1,, H.Milionis H.Milionis 2, E.Manios, E.Manios 3, P. Michel, P. Michel 4, G.Y.H. Lipe, G.Y.H. Lipe 5, K. Vemmos, K. Vemmos3

1 Department of Medicine, University of Thessaly, Larissa, Greece2 Department of Medicine, University of Ioannina, Ioannina, Greece3 Department of Clinical Therapeutics, University of Athens, Athens, Greece4 Acute Stroke Unit, CHUV, University of Lausanne, Lausanne, Switzerland5 University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom

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• Statin therapy in ischemic stroke patients of presumably atherosclerotic origin. (ACC/AHA guidelinesACC/AHA guidelines))

• NNoo recommendation for statin therapy in stroke patients of non-atherosclerotic origin, e.g. strokes related to atrial fibrillation (AF).

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DoesDoes statin treatment in patients with AF-related stroke

affect affect on survival & risk for stroke recurrence & future cardiovascular events????

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Inclusion criteriaInclusion criteria

Acute first-ever ischemic stroke AF-related stroke No history of coronary artery disease (CAD) No clinically manifest peripheral artery disease

Athens Stroke Registry Between January 2000 and December 2011

**Patients with transient ischaemic attack (TIA) or recurrent stroke not not included in the analysis

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MethodsMethods

2 groups:

-off-statin

-on-statin at discharge

follow-up:

After 1, 3 & 6 months & yearly -Primary outcome: overall mortality

-Secondary outcomes: stroke recurrence & a composite cardiovascular endpoint (recurrent stroke, myocardial infarction, aortic aneurysm rupture or sudden cardiac death)

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ResultsResults

Among 1602 stroke patients, 404 (25.2%) with AF-related stroke were included in the analysis.

102 of them (25.2%) were discharged on statin & 302 (74,8%) without statin.

92 cardiovascular events in 72 patients during a median follow-up of 22 months (Table 1).

Significant difference between the 2 groups in the rate of sudden cardiac death (2% in the on-statin group vs. 10.6% in the off-statin group).

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ResultsResults

ResultsResults

Statin treatment was independently associated with lower mortality during the median 22 months follow-up (Table 2).

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ResultsResults

ResultsResults

Significantly different cumulative probability of survival during the median 22 months between the 2 groups (Figure 1).

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Figure 1.Figure 1. Kaplan–Meier curves of the 5-years' cumulative probability of overall survival.

ResultsResults

ResultsResults

Statin treatment was independently associated with a lower risk for the composite cardiovascular endpoint during the median 22 months follow-up (Table 2).

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ResultsResults

ResultsResults

Significantly different cumulative probability of new cardiovascular event between the on-statin & off-statin group (Figure 2).

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FigFigureure 2. 2. Kaplan–Meier curves of the 5-years' cumulative probability of new cardiovascularevent.

ResultsResults

ResultsResults

Statin treatment was notnot associated with stroke recurrence during the median 22 months follow-up, despite a strong trend in favor of the on-statin group (Table 2).

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ResultsResults

ResultsResults

Difference of borderline statistical significance in the cumulative probability of stroke recurrence between the on-statin & the off-statin group (Figure 3).

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ResultsResults

FigFigureure 3. 3. Kaplan–Meier curves of the 5-years'

cumulative probability of stroke recurrence

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DiscussionDiscussion

Association of statin treatment with improved survival & reduced risk for future cardiovascular events, in these patients with AF-related stroke.

NNoo significant difference between on-statin & offstatin groups with regards to the endpoint of stroke recurrence.

The beneficial effect of statins in patients with AF-related stroke was driven by the reduction of cardiovascular notnot cerebrovascular events.

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DiscussionDiscussion

Although there is no specific recommendation about patients with AF-related stroke, many clinicians start statin.

This needs confirmconfirmationation in a randomized trial setting.

Similar findings in an analysis of a Korean stroke registry.

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MMain strengthsain strengths of study of study

Assessment of mortality, stroke recurrence & cardiovascular events and the median follow-up period of 22 months in a consecutive series of stroke patients.

Analysis notnot restricted to dyslipidemic patients.

AAllll patients were included* irrespective of their baseline LDL levels.

*patients with AFrelated stroke is a high-risk group for stroke recurrence & future cardiovascular events and cardiovascular & overall mortality

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LimitationsLimitations

Collection & entry bias

Residual confounding

Adherence to statin treatment notnot assessed

Efficiency of anticoagulation notnot available (the time within therapeutic range (TTR), for patients receiving vitamin-K antagonists)

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SummarySummary

Statin treatment in patients with AF-related stroke was associated with improved survival & reduced risk for future cardiovascular events in this long-term registry.

The beneficial effect of statins in patients with AF-related stroke was driven by the reduction of cardiovascular cardiovascular rather than cerebrovascular events.

Further confirmation is urgently warranted in a randomized trial setting, given the high incidence of AF-related stroke & its poor prognosis.

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Thank you Thank you

for your attentionfor your attention