Early statin use might reduce the hemorrhagic transformation among acute ischemic stroke patients with recanalization therapy: a retrospective cohort study

Boyan Pan¹Jiaying Lan¹Xiaojun Li²Haoxuan Chen³Luankun Weng⁴Haoyou Xu⁴Yuanqi Zhao^4*Min Zhao^1*

• ¹Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
• ²Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhuo University of Traditional Chinese Medicine, Zhongshan, China
• ³The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Zhuhai, China
• ⁴The Second Affiliated Hospital, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China

Objective: To evaluate the relationship between early statin administration and hemorrhagic transformation (HT) in patients with acute ischemic stroke (AIS) patients following recanalization therapy.Methods: This retrospective study included AIS patients who underwent recanalization therapy (intravenous thrombolysis, endovascular treatment, or a combination of both) and categorized them into two groups based on whether statins were administered within 24 hours of recanalization therapy.The primary outcome was the occurrence of HT during hospitalization. Secondary outcomes included in-hospital mortality, favorable clinical outcomes (mRS 0-2) at discharge, and neurological improvement 7±2 days post-stroke (defined as a reduction of ≥4 points in NIHSS from baseline).Results: A total of 266 AIS patients were analyzed, with 164 (61.7%) receiving statins within 24 hours (24h-statins group). The 24h-statins group demonstrated a significantly lower risk of HT compared to the non-24h-statins group (4.9% vs. 21.6%, p < 0.001). In-hospital mortality was also lower in the 24h-statins group, although not statistically significant (4.9% vs. 10.8%, p = 0.076).Favorable clinical outcomes were more frequent in the 24h-statins group than in the non-24h-statins group (60.5% vs. 36.7%, p < 0.001). Furthermore, a greater proportion of patients in the 24h-statins group showed neurological improvement (51.8% vs. 35.1%, p = 0.019). Adjusted multivariate analysis revealed that early statin use was independently associated with a reduced risk of HT (OR 0.16, 95% CI 0.06-0.49, p < 0.001), as well as a positive association with favorable clinical outcomes (OR 3.63, 95% CI 1.42-9.28, p = 0.007) and neurological improvement (OR 5.23, p < 0.001). Subgroup analysis indicated that among patients with elevated lowdensity lipoprotein (LDL) levels, early statin therapy was linked to a lower risk of HT (P for interaction = 0.018).Early statin administration within 24 hours of recanalization therapy, in AIS patients was associated with reduced risk of HT and improved neurological outcomes. For patients with elevated LDL levels, early statin therapy may further decrease the risk of HT.