Abstract 66: Dynamics of Statin Use and Outcomes After Recanalization Treatment for Acute Ischemic Stroke: When, How Much and for Whom?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Han-Gil Jeong ◽  
Beom Joon Kim ◽  
Mi-Hwa Yang ◽  
Moon-Ku Han ◽  
Hee-Joon Bae
Keyword(s):  
Ischemic Stroke ◽  
High Intensity ◽  
Medication Administration ◽  
Moderate Intensity ◽  
Large Artery ◽  
Bar Code ◽  
National University ◽  
Seoul National University ◽  
Improved Outcome ◽  
Statin Use

Introduction: Statin has the potential to be effective in the early phase of recanalization. However it is largely unknown in which group, when, and at what doses statin use is beneficial after recanalization. Methods: From a total of 7663 stroke cases of Seoul National University Bundang Hospital between July 2007 and Dec 2015, we collected eligible cases with the following inclusion criteria; (1) Lesion-documented ischemic stroke (N=6151); (2) received recanalization treatment (N=908). We excluded cases with missing in (1) the time information (N=26) and (2) modified Rankin Score (mRS) at 3 months (N=1). We gathered the exact timing, type, dose of statin use from a database of electronic bar-code medication administration system. Multivariable ordinal logistic regression was performed for mRS at 3 months (improved outcome). Results: Of the 881 analyzable cases (male, 58%; mean age, 68.9; median initial NIHSS score, 12), recanalization treatment consisted of 33% of IV-only, 33% of IA-only and 34% of combined IV-IA strategies. Stroke mechanisms were 26% of large artery atherosclerosis (LAA), 49% of cardioembolism (CE) and 25% of non-LAA/CE. Statins were administered in the acute phase (within 7 days) in 68% (n=598) patients (<24 hours in 35% [n=307] and 24-72 hours in 43% [n=170]). High intensity statins (atorvastatin 40-80 mg or rosuvastatin 20 mg) were used in 72% (n=429) and low-to-moderate intensity statins in 28% (n=169). Multivariable analyses revealed acute statin (within 7 days) was associated with improved outcome, especially in patients with IA treatment or when used within 24 hours. Low-to-moderate intensity statin was associated with improved outcome, but high intensity statin was not. Conclusions: Acute statin use after recanalization treatment may positively influence functional outcome, more in patients with IA treatment or when used within 24 hours. Low-to-moderate intensity statin may be as beneficial as high intensity statin after recanalization.

Abstract TMP45: Usefulness of Susceptibility Vessel Sign With Bright Vessel Appearance in Acute Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Han-Gil Jeong ◽  
Beom-Joon Kim ◽  
Chi Kyung Kim ◽  
Jun Yup Kim ◽  
Dong-Wan Kang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Arterial Occlusion ◽  
University Hospital ◽  
Large Artery ◽  
Peripheral Arteries ◽  
Inclusion Criteria ◽  
Arterial Segment ◽  
Susceptibility Effect ◽  
National University ◽  
Seoul National University

Background: Red thrombi, composed of fibrin and trapped erythrocytes, have magnetic susceptibility effect. Susceptibility vessel sign (SVS) is visualized more sensitively using susceptibility weighted imaging (SWI) than T2*-weighted imaging. Bright vessel appearance (BVA) on arterial spin labeling (ASL) imaging can visualize occluded arterial segment by arterial transit artifact, more sensitively in small and peripheral branches. We investigated the usefulness of SWI-SVS with BVA to visualize different thrombus and predict stroke mechanisms. Methods: From a total of 564 stroke cases who admitted to Seoul National University Hospital in 2014, the authors collected eligible cases with the following inclusion criteria; (1) Lesion-documented ischemic stroke (N=425); (2) SWI and ASL MRI performed (N=407); (3) Symptomatic arterial occlusion with BVA (N=141). All images were analyzed for the presence and location of SWI-SVS and BVA. The location of SWI-SVS and BVA were classified into (1) proximal, large arteries; distal ICA, M1/2, A1, P1, basilar artery, V4 and (2) peripheral, small arteries; M3/4, P2/3, A2/3, lenticulostriate arteries, three cerebellar arteries. The relationships between SWI-SVS in the presence of BVA and stroke etiologies are explored. Results: Male was 58.2% (n=82) and mean age was 65.7±14.3. Thirty-four percent (n=48/141) of BVA and 30.3% (n=30/99) of SVS was located within small, peripheral arteries. SWI-SVS was more commonly associated with other determined etiology (20.2% vs. 4.8%) and cardioembolism (39.4% vs. 14.3%), but less with large artery atherosclerosis (26.3% vs. 69.0%, P <0.01) compared to the patients without SWI-SVS. Cancer-related hypercoagulability (60%, n=12/20) was most common in other determined cases with SWI-SVS. Multivariate analysis showed that SWI-SVS was an independent predictor of other determined etiology (adjusted OR, 7.20; 95% CI, 1.48-34.99) and cardioembolism (adjusted OR, 5.76; 95% CI, 1.27-26.02) Conclusions: SWI-SVS with BVA may predict ischemic stroke of cardioembolism and other determined etiology. Occlusions of small, peripheral arteries are well visualized with BVA and composition of thrombus can be identified by SWI-SVS.

Abstract WP342: Antithrombotics Within 24 Hours After Recanalization Treatment: Is it Safe?

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Beom Joon Kim ◽  
Han-Gil Jeong ◽  
Mi-Hwa Yang ◽  
Moon-Ku Han ◽  
Seong-Ho Park ◽  
...  
Keyword(s):  
Medication Administration ◽  
Hemorrhagic Transformation ◽  
Early Initiation ◽  
Bleeding Complications ◽  
Bar Code ◽  
National University ◽  
Multivariable Analyses ◽  
Seoul National University ◽  
Time Information ◽  
Exact Timing

Background: Majority of hemorrhagic transformation (HTf) occurs within 24 hours after IV or IA treatment, and earlier antithrombotics may be useful in preventing early reocclusions or ischemic neurologic deteriorations. However, the safety of early antithrombotics ≤24-hour after recanalization treatment is not sufficiently evaluated. Methods: From a total of 6777 stroke cases who admitted to Seoul National University Bundang Hospital between July 2007 and March 2015, the authors collected eligible cases with the following inclusion criteria; (1) Lesion-documented ischemic strokes (N=5451); (2) received recanalization treatments (N=792). We excluded 72 cases with (1) missing in the time information (N=19), (2) ultraearly bleeding complications (N=41), (3) extremely grave prognosis (N=5), and (4) surgical treatment (N=7). We systemically gathered the exact timing of antithrombotics use from a database of electronic bar-code medication administration system. Results: Of the 720 analyzable cases, male was 57% (n=407), mean age was 68.9 ± 12.8, and median NIHSS score was 12 [7 - 19] point. Recanalization treatment was consisted of 34% (n=243) of IV-only, 32% (=231) of IA-only, and 34% (n=246) of combined IV-IA strategies. Outcomes after stroke was as following; 218 (30%) any HTf, 31 (4%) symptomatic HTf, and 266 (37%) mRS score 0 - 1 at 3 months. In this population, antithrombotics were initiated within 24 hours after recanalization treatment in 64% (n=458) of cases and within 12 hours in 24% (n=170) of patients. Multivariable analyses revealed that early initiation of antithrombotics within 24 hours after recanalization treatment was significantly associated with lower odds of having any HTf (adjusted OR, 0.69; 95% CI, 0.48 - 0.98). Early initiation was not significantly associated with symptomatic HTf (0.71; 0.34 - 1.46) and mRS score 0 - 1 at 3 months after stroke (1.41; 0.97 - 2.06). Conclusions: Earlier initiation of antithrombotics within 24 hours after recanalization treatment may not increase hemorrhagic complications after stroke. Further clinical research is warranted to clarify which subgroup of stroke patients will benefit of earlier antithrombotics.

scholarly journals Association of Carotid Artery Endothelial Signal Intensity Gradient with Unilateral Large Artery Ischemic Stroke

2021 ◽  
Vol 50 (3) ◽  
pp. 270-278
Author(s):  
Chan-Hyuk Lee ◽  
Sang Hyuk Lee ◽  
Young I. Cho ◽  
Seul-Ki Jeong
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Signal Intensity ◽  
Internal Carotid ◽  
University Hospital ◽  
Large Artery ◽  
Intensity Gradient ◽  
National University ◽  
Endothelial Shear Stress ◽  
Stroke Center

<b><i>Background:</i></b> Common carotid artery (CCA) and internal carotid artery (ICA) are aligned linearly, but their hemodynamic role in ischemic stroke has not been studied in depth. <b><i>Objectives:</i></b> We aimed to investigate whether CCA and ICA endothelial shear stress (ESS) could be associated with the ischemic stroke of large artery atherosclerosis (LAA). <b><i>Methods:</i></b> We enrolled consecutive patients with unilateral ischemic stroke of LAA and healthy controls aged &#x3e;60 years in the stroke center of Jeonbuk National University Hospital. All patients and controls were examined with carotid artery time-of-flight magnetic resonance angiography, and their endothelial signal intensity gradients (SIGs) were determined, as a measure of ESS. The effect of right or left unilateral stroke on the association between carotid artery endothelial SIG and ischemic stroke of LAA was assessed. <b><i>Results:</i></b> In total, the results from 132 patients with ischemic stroke of LAA and 121 controls were analyzed. ICA endothelial SIG showed significant and independent associations with the same-sided unilateral ischemic stroke of LAA, even after adjusting for the potential confounders including carotid stenosis, whereas CCA endothelial SIG showed a significant association with the presence of the ischemic stroke of LAA. <b><i>Conclusion:</i></b> Although CCA and ICA are located with continuity, the hemodynamics and their roles in large artery ischemic stroke should be considered separately. Further studies are needed to delineate the pathophysiologic roles of ESS in CCA and ICA for large artery ischemic stroke.

Abstract 188: Hospital and Regional Variation in Use of High-intensity Statins Following Myocardial Infarction Among Medicare Beneficiaries

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Emily B Levitan ◽  
Paul Muntner ◽  
Yu Ling Dai ◽  
Mark Woodward ◽  
Matthew Mefford ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Medical School ◽  
High Intensity ◽  
Lower Percentage ◽  
Moderate Intensity ◽  
Medicare Beneficiaries ◽  
American Hospital ◽  
Hospital Size ◽  
School Affiliation ◽  
Statin Use

Background: American College of Cardiology/American Heart Association guidelines published in 2013 recommend high-intensity statins (atorvastatin 40 or 80 mg or rosuvastatin 20 or 40 mg) for most adults ≤75 years of age with atherosclerotic cardiovascular disease (ASCVD). For adults >75 years of age with ASCVD, the guidelines recommend continuation of tolerated statins or initiation of moderate intensity statins for most patients. Objective: To examine whether guideline concordant use of high-intensity statins following myocardial infarction (MI) among Medicare beneficiaries differed by hospital size, medical school affiliation, and region of the US in 2014 (after publication of the guidelines). Methods: We identified 28,086 Medicare beneficiaries with fee-for-service and pharmacy coverage who filled a statin within 30 days following hospital discharge for MI in 2014. The analyses were restricted to 731 hospitals with at least 20 beneficiaries discharged for MI in 2014. Hospital size and medical school affiliation were determined from the American Hospital Association survey. In subgroups ≤75 and >75 years of age, we calculated the proportion of beneficiaries whose first statin fill after MI was a high-intensity statin by hospital, hospital size, medical school affiliation, and region. Results: Among statin users ≤75 years of age, 10,696 (55%) beneficiaries filled a prescription for a high-intensity statin following MI. The percentage filling high-intensity statins range from 0-100% (25 th percentile 39%, 75 th percentile 69%) across hospitals. High-intensity statin use was more common following hospitalization at larger hospitals, hospitals with medical school affiliations, and those in New England ( Figure ). A lower percentage of Medicare beneficiaries >75 years of age filled high-intensity statins (n = 8,441, 44%), but patterns were similar across hospital characteristics and region. Conclusions: Similar patterns of high-intensity statin use were present among individuals ≤75 years of age, in whom high-intensity statin use is guideline concordant, and individuals >75 years of age, in whom high-intensity statin use is not necessarily guideline concordant, suggesting that variation in high-intensity statin prescriptions may not be directly related to close adherence to guidelines.

scholarly journals Stroke prevention by direct revascularization for patients with adult-onset moyamoya disease presenting with ischemia

2016 ◽  
Vol 124 (6) ◽  
pp. 1788-1793 ◽  
Author(s):  
Tackeun Kim ◽  
Chang Wan Oh ◽  
O-Ki Kwon ◽  
Gyojun Hwang ◽  
Jeong Eun Kim ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Moyamoya Disease ◽  
Protective Factor ◽  
Control Group ◽  
Number Needed To Treat ◽  
Large Sample Size ◽  
Adult Onset ◽  
National University ◽  
Seoul National University ◽  
Revascularization Surgery

OBJECT Moyamoya disease (MMD) is a progressive disease that can cause recurrent stroke. The authors undertook this retrospective case-control study with a large sample size in an attempt to assess the efficacy of direct or combined revascularization surgery for ischemia in adults with MMD. METHODS The authors investigated cases involving patients with moyamoya disease presenting with ischemia who visited Seoul National University Bundang Hospital and Seoul National University Hospital between 2000 and 2014. Among 441 eligible patients, 301 underwent revascularization surgery and 140 were treated conservatively. Variables evaluated included age at diagnosis, sex, surgical record, Suzuki stage, and occurrence of stroke. Patients were stratified into 2 groups based on whether or not they had undergone revascularization surgery. Actuarial 1-, 5-, and 10-year stroke rates were calculated using the life table method. Risk factor analysis for 5-year stroke occurrence was conducted with multivariate regression. RESULTS Of the 441 patients, 301 had been surgically treated (revascularization group) and 140 had not (control group). The mean follow-up durations were 45 and 77 months, respectively. The actuarial 10-year cumulative incidence rate for any kind of stroke was significantly lower in the revascularization group (9.4%) than in the control group (19.6%) (p = 0.041); the relative risk reduction (RRR) was also superior (52.0%) in the revascularization group, and the number needed to treat was 10. The 10-year rate of ischemic stroke was greater (13.3%) in the control group than in the revascularization group (3.9%) (p = 0.019). The RRR for ischemic stroke in the revascularization group was 70.7%, and the number needed to treat was 11. However, the actuarial 1- and 5-year rates of ischemic stroke did not significantly differently between the groups. Overall, revascularization surgery was shown to be an independent protective factor, as revealed by multivariate analysis. CONCLUSIONS Direct or combined revascularization for patients with adult-onset moyamoya disease presenting with ischemia can prevent further stroke.

Abstract W P269: High vs. Moderate-intensity Statin Therapy After Ischemic Stroke: Findings from PROSPER

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Melissa A Greiner ◽  
Emily O'Brien ◽  
Ying Xian ◽  
Deepak L Bhatt ◽  
Lesley Maisch ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Statin Therapy ◽  
High Intensity ◽  
Older Patients ◽  
Negative Binomial ◽  
Treatment Guidelines ◽  
Care Facility ◽  
Moderate Intensity ◽  
Major Adverse Cardiovascular Events ◽  
Stroke Patients

Background: Current treatment guidelines recommend high-intensity statin therapy for patients with a history of stroke. However, older patients with higher comorbidity were under-represented in trials and dosing varies in clinical practice. We compared the effectiveness of high vs moderate-intensity statins on clinical outcomes in older patients from the GWTG-Stroke registry. Methods: We studied statin-naïve ischemic stroke patients ≥65 years from GWTG-Stroke linked to Medicare claims from 2008-2011 who were discharged on statins. Outcomes included home time days (days alive and not in acute or post-acute care facility), major adverse cardiovascular events (MACE), mortality, all-cause, stroke and CV readmission within 2 years of discharge. We estimated unadjusted and adjusted associations between statin intensity and outcomes using negative binomial and Cox proportional hazards models. Inverse-weighted estimates of the probability of high-intensity statin (IPW) were used to adjust for treatment selection. Results: Of 29,631 ischemic stroke patients discharged on statins, 9,145 (31%) received high-intensity statins. Patients receiving high-intensity statins were younger and had higher LDL-C compared with patients on moderate-intensity statins. The high-intensity statin group had 5 fewer home time days and higher all-cause readmission within 2 years, but other observed outcomes were similar (Table). Except for a slightly higher hazard of all-cause readmission with high-intensity statin use, there were no significant differences in MACE, hemorrhagic stroke, or other outcomes after IPW adjustment (Table). Conclusions: We found no differences in MACE or home time days within 2 years of initiation of high vs. moderate-intensity statin therapy following ischemic stroke. These findings can inform patients and clinicians regarding the risk-benefit associated with statin dosing after ischemic stroke.

Abstract P523: Mechanical Thrombectomy for in Hospital Stroke: A Single Center Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jeonghoon Bae ◽  
Eung-joon Lee ◽  
Byung-woo Yoon
Keyword(s):  
Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Multivariable Analysis ◽  
Functional Independence ◽  
Underlying Disease ◽  
University Hospital ◽  
Single Center Study ◽  
National University ◽  
Baseline Characteristics ◽  
Seoul National University

Purpose: There are many differences between in hospital ischemic stroke(IHS) and community onset ischemic stroke(COS), and there are several comparative studies. Although the importance of mechanical thrombectomy(MT) in the treatment of acute ischemic stroke is becoming increasingly important, there are not many studies on the effectiveness of MT in IHS. We aimed to compare the clinical features and outcomes between IHS and COS patients who received MT. Methods: We analyzed cases of mechanical thrombectomy performed at Seoul National University Hospital from January 2012 to June 2020. We selected patients with previous mRS(modified Rankin Scale) 0-1 and then divided them into two groups: IHS and COS, and compared successful recanalization, discharge mRS, 3month mRS, and 3month functional independence (mRS 0-2). Results: A total of 41 patients with IHS and 213 patients with COS were included. The baseline characteristics(age, sex, underlying disease, occlusion site) of the two groups were similar, but malignancy tended to be more common in IHS than COS(19.5% vs 7.5%). The median/mean LNT(last normal time)-to-puncture time was 341min/399min in IHS and 370min/461min in COS. The percentages of successful recanalization (92% vs 89%), discharge mRS (mean, 2.19 vs 2.97), 3 month mRS (mean, 2.05 vs 2.56), 3 month functional independence (61% vs 49%) were comparable between the two groups. In the multivariable analysis of the 3 month functional independence, initial NIHSS and successful recanalization were the most important predictors. In addition, a multivariable analysis was performed on successful recanalization, and LNT to puncture time was the most important predictor. Conclusions: The importance of MT is still high even in the in hospital stroke. In addition, IHS has more factors that can reduce the onset to puncture time compared to COS such as well designed on-call system and patient transfer system, well arrangement of nursing manpower. Therefore, more attention is needed for MT in IHS.

Statins Use and Outcome of Acute Ischemic Stroke Patients after Systemic Thrombolysis

2020 ◽  
Vol 49 (5) ◽  
pp. 503-508
Author(s):  
Ashkan Mowla ◽  
Harshit Shah ◽  
Navdeep Singh Lail ◽  
Caila B Vaughn ◽  
Peyman Shirani ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
High Intensity ◽  
Multivariate Model ◽  
Systemic Thrombolysis ◽  
Low Intensity ◽  
Poor Outcome ◽  
History Of ◽  
Symptomatic Intracranial Hemorrhage ◽  
Statin Use

<b><i>Aim:</i></b> The aim of this was to study the effects of statins and their intensity on symptomatic intracranial hemorrhage (sICH) and outcome after IV thrombolysis (IVT) for acute ischemic stroke (AIS). <b><i>Methods:</i></b> We retrospectively reviewed the medical records and cerebrovascular images of all the patients treated with IVT for AIS in our center in a 10-year period. Patients were further characterized as any statin users versus non-users on admission to the emergency department. Statins were categorized in high intensity or low intensity statin based on its propensity to reduce lower low-density cholesterol by ≥45% or &#x3c;45%, respectively. Safety and discharge modified Rankin Score were compared between statin users versus non-users and also between high-intensity versus low-intensity groups. <b><i>Results:</i></b> A total of 834 patients received IVT for AIS in our center during a 10-year period. Multivariate models were adjusted for age, NIH Stroke Scale at admission, INR, and history of DM and atrial fibrillation. There was no association between odds of sICH and any statin use (OR = 0.52 [0.26–1.03], <i>p</i> = 0.06). In multivariate model, any statin use was not associated with odds of poor outcome (Table 4: OR = 1.01 [0.79–1.55], <i>p</i> = 0.57). There was no significant association between odds of sICH among patients on high-intensity statin compared to low intensity statin (multivariate model OR = 0.39 [0.11–1.40], <i>p</i> = 0.15). There was 47% reduced odds of poor outcome among patients on high-intensity statin as compared to low-intensity statin (OR = 0.53[0.32–0.88] <i>p</i> = 0.01). However, this significant association was lost in the multivariate model (OR = 0.60 [0.35–1.05], <i>p</i> = 0.07). <b><i>Conclusion:</i></b> Our study does not show any significant association between risk of sICH and poor outcome after IVT for patients on prior statin therapy. We also did not find significant association between the risk of sICH and poor outcome after IVT and the intensity of the stain used.

4115Effect of alirocumab on recurrent cardiovascular events after acute coronary syndrome, according to the intensity of background statin treatment

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Diaz ◽  
Q H Li ◽  
D L Bhatt ◽  
V A Bittner ◽  
M T Baccara-Dinet ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
High Intensity ◽  
Cardiovascular Events ◽  
Statin Treatment ◽  
Moderate Intensity ◽  
Major Adverse Cardiovascular Events ◽  
P Value ◽  
Coronary Syndrome ◽  
To Receive ◽  
Statin Use

Abstract Background Statins are a cornerstone of therapy for coronary heart disease. We describe the effects of alirocumab (ALI) in patients (pts) with recent acute coronary syndrome (ACS) and dyslipidaemia per category of statin use. Methods ODYSSEY OUTCOMES compared ALI with placebo (PBO) in 18,924 pts with recent ACS and dyslipidaemia despite high-intensity/maximum tolerated statin (atorvastatin 40–80 mg/d or rosuvastatin 20–40 mg/d). Lower doses could be used if there were symptoms, laboratory abnormalities, or contraindications with higher doses. In cases of documented intolerance to ≥2 statins, pts could qualify on no statin treatment. Pts were randomized to ALI (75 mg SC Q2W, with possible uptitration to 150 mg Q2W) or PBO. Median follow-up was 2.8 years. Primary endpoint was major adverse cardiovascular events (MACE: CHD death, non-fatal MI, ischaemic stroke, or unstable angina requiring hospitalization). Pts were categorized by statin therapy at baseline: high intensity (88.8%), low or moderate intensity (8.7%), or no statin use (2.4%). In each category we determined the relative (hazard ratio [HR]) and absolute risk reductions (ARR) for MACE with ALI. Results Overall, ALI reduced MACE (HR 0.85, 95% CI 0.78–0.93; P<0.001). HRs were consistent across statin categories (Table). Baseline LDL-C increased across high-intensity, low/moderate-intensity, and no statin categories. Correspondingly, there was a gradient of the risk of MACE in the PBO group across these categories (10.8%, 10.7%, and 26%). With ALI treatment, the mean reduction in LDL-C from baseline to Month 4 increased across the 3 statin categories and correspondingly the ARRs for MACE were 1.3%, 3.2%, and 8.0% (P interaction <.001). LDL-C values and MACE events All patients High-intensity statin Low-/moderate-intensity statin No statin Interaction P-value N=18,924 (100%) N=16,811 (88.8%) N=1653 (8.7%) N=460 (2.4%) (treatment x statin category) PBO (N=9462) ALI (N=9462) PBO (N=8431) ALI (N=8380) PBO (N=804) ALI (N=849) PBO (N=227) ALI (N=233) LDL-C at baseline, mmol/L, mean (SE)* 2.39 (0.01) 2.39 (0.01) 2.35 (0.01) 2.35 (0.01) 2.41 (0.03) 2.43 (0.03) 3.76 (0.08) 3.82 (0.08) Change in LDL-C from baseline to Month 4, mmol/L, mean (SE) 0.03 (0.01) −1.4 (0.01) 0.03 (0.01) −1.37 (0.01) 0.01 (0.02) −1.47 (0.02) −0.004 (0.06) −2.27 (0.06) <0.001 MACE, n (%)* 1052 (11.1) 903 (9.5) 907 (10.8) 797 (9.5) 86 (10.7) 64 (7.5) 59 (26.0) 42 (18.0) HR (95% CI) 0.85 (0.78−0.93) 0.88 (0.80−0.96) 0.69 (0.50−0.95) 0.65 (0.43−0.96) 0.14 ARR (%) (95% CI) 1.6 (0.7−2.4) 1.3 (0.3−2.2) 3.2 (0.4−5.9) 8.0 (0.4−15.5) <0.001 *P<0.001 for difference among statin categories. Conclusions In ODYSSEY OUTCOMES, patients unable to receive high-intensity statin treatment showed greater ARRs with ALI, consistent with higher baseline LDL-C concentration and greater absolute LDL-C reduction. Patients unable to receive high-intensity statin treatment are an important group to consider for treatment with ALI after ACS. Acknowledgement/Funding Funded by Sanofi and Regeneron Pharmaceuticals

Abstract 195: Statin Use and Its Facility Level Variation in Patients With Ischemic Cerebrovascular Disease: Insights From the Department of Veterans Affairs

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Cameron L McBride ◽  
Julia Akaroyd ◽  
David J Ramsey ◽  
Vijay Nambi ◽  
Khurram Nasir ◽  
...  
Keyword(s):  
Cerebrovascular Disease ◽  
Statin Therapy ◽  
High Intensity ◽  
Veterans Affairs ◽  
Prescribing Patterns ◽  
Moderate Intensity ◽  
Level Variation ◽  
Ischemic Cerebrovascular Disease ◽  
Facility Level ◽  
Statin Use

Background: The 2013 ACC/AHA cholesterol guideline recommends high-intensity statin therapy in patients 75 or younger and moderate-intensity statins in patients > 75 years with atherosclerotic cardiovascular disease including those with ischemic cerebrovascular disease (ICVD). Statin prescribing patterns and their facility-level variation in patients with ICVD are unknown. Methods: We examined the frequency and facility-level variation in the use of any and correct intensity statins in patients with ICVD (ischemic stroke or carotid arterial disease) who received primary care in 130 facilities across the Veterans Affairs (VA) health care system with or without concomitant ischemic heart disease (IHD) or peripheral artery disease (PAD). We then calculated median rate ratios (MRR) adjusted for patient demographic factors to assess the magnitude of facility-level variation in statin prescribing patterns for comparable patients. Results: Among 339,771 ICVD patients, 182,231 (53.6%) had ICVD without IHD (with or without PAD) and 163,730 (48.2%) had ICVD without IHD or PAD. Rates of statin use in the entire ICVD group, patients with ICVD without IHD, and ICVD alone were 78.1%, 70.9% and 69.9%, respectively. Median facility-level rates of any statin use were 78.1% (IQR 75.5-80.7), 70.7% (67.9-73.8) and 69.9% (66.9-73.1), respectively. Correct intensity statins were prescribed among 40.2% of the entire ICVD group, 30.5% with ICVD without IHD, and 29.6% with ICVD alone. Median facility-level rate of correct statin use in all ICVD patients was 39.1% (35.8-43.9), 29.9% (26.0-34.6) for patients with ICVD without IHD and 29.0% (25.4-33.7) in those with ICVD alone.Calculated MRRs reflect approximately 22% variation among two facilities treating two identical ICVD patients with statin therapy and a 27-28% variation in identical ICVD patients for correct statin intensity (Table). Conclusions: The use of statin and especially guideline-recommended statin intensity is suboptimal in ICVD patients, especially patients without concomitant IHD or PAD. There is significant facility-level variation in receipt of guideline directed statin therapy in ICVD patients. Interventions are needed to improve guideline directed moderate to high-intensity statin use and reduce variation in care in this high risk group.

Sign in / Sign up

Export Citation Format

Share Document