The impact of pre-stroke statin use on baseline corrected infarct volume and collateral perfusion
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Stroke is a leading cause of disability and mortality worldwide, with ischaemic stroke the most prevalent type. Statins, used for cholesterol management, have demonstrated benefits in reducing stroke risk and improving outcomes in preclinical studies. However, the impact of pre-stroke statin use on stroke outcomes remain inconsistent. In this study, we aim to evaluate whether pre-stroke statin use is associated with greater volume of salvaged tissue and improved cerebral collateral perfusion.
A retrospective analysis was conducted using data from 281 patients presenting with acute ischemic stroke to the John Hunter Hospital between May 2015 and May 2020. Patients were grouped based on pre-stroke statin use, and clinical variables, including infarct volume and collateral perfusion, were assessed. The primary outcome was salvage volume derived from baseline perfusion lesion volume minus infarct volume at follow-up. Collateral perfusion was measured by the hypoperfusion volume defined by delay time (DT)>6 seconds divided by the hypoperfusion volume defined by DT >2 seconds.
Patients on statins at admission were significantly older and had more comorbidities. No significant association was found between pre-stroke statin use and salvage volume or collateral perfusion after adjusting for covariates. Larger initial infarct core was a significant predictor of salvage volume due to larger salvageable tissue volume at baseline. These findings indicate that pre-morbid statin use is not associated with larger salvage volume or improved cerebral collateral perfusion.
Highlights
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There is pre-clinical and clinical evidence that pre-stroke statin use is protective but randomised controlled trials (RCTs) have not replicated these findings.
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Performed retrospective analysis of salvage volume in stroke patients with and without pre-morbid statin use.
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Pre-stroke statin use was not associated with greater salvage volume or improved cerebral collateral perfusion.
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Baseline infarct volume was the most significant predictor of salvage volume due to those with a larger initial infarct core having a greater volume of hypoperfused tissue.
