Immediate- or Delayed-Intensive Statin in Acute Cerebral Ischemia-Reference-Cited by-同舟云学术

Immediate- or Delayed-Intensive Statin in Acute Cerebral Ischemia

Published:2024-07-01 Issue:7 Volume:81 Page:741
ISSN:2168-6149
Container-title:JAMA Neurology
language:en
Short-container-title:JAMA Neurol

Author:

Gao Ying¹,Jiang Lingling²,Pan Yuesong¹²,Chen Weiqi¹,Jing Jing¹²,Wang Chunjuan¹²,Johnston S. Claiborne³,Amarenco Pierre⁴⁵,Bath Philip M.⁶,Yang Yingying¹,Wang Tingting¹,Han Shangrong¹,Meng Xia¹²,Lin Jinxi²,Zhao Xingquan¹²,Liu Liping¹²,Zhao Jinguo⁷,Li Ying⁸,Zang Yingzhuo⁹,Zhang Shuo¹⁰,Yang Hongqin¹¹,Yang Jianbo¹²,Wang Yuanwei¹³,Li Dali¹⁴,Wang Yanxia¹⁵,Liu Dongqi¹⁵,Kang Guangming¹⁶,Wang Yongjun¹²¹⁷¹⁸¹⁹,Wang Yilong¹²¹⁷¹⁸²⁰, ,Wang Zhimin²¹,Guo Jianmin²¹,Song Xiujuan²¹,Wang Xinqiang²¹,Lu Weifeng²¹,Huang Panbing²¹,Li Feng²¹,Wang Lihua²¹,Xiao Weigang²¹,Cao Yibin²¹,Rong Liangqun²¹,Xing Ying²¹,Ma Lili²¹,Zhou Yanhua²¹,Han YuQing²¹,Fang Jingxian²¹,Liu Jie²¹,Shangguan Wen²¹,Liu Bin²¹,Li Jianhua²¹,Han Yan²¹,Song Chengguang²¹,Song Xuhong²¹,Lv Yuanfeng²¹,Xu Changqing²¹,Ma Congmin²¹,Duan Zhihui²¹,Pan Yungao²¹,Ren Lijie²¹,Li Bin²¹,Fan Jinqi²¹,Zhang Yuanren²¹,Li Jingfang²¹,Wang Baojun²¹,Gu Jun²¹,Yin Xiaoping²¹,Wang Xiao²¹,Chang Liguo²¹,Gong Kaoling²¹,Zhang Wenhua²¹,Che Yu²¹,Wan Yinyuan²¹,Gui Linying²¹,Sun Ping²¹,Jia Zhonghai²¹,Liu Haichao²¹,Meng Qinglian²¹,Chai Donghe²¹,Zhang Lei²¹,Li Guofeng²¹,Jin Huafeng²¹,Liu Gexia²¹,Tang Yonghong²¹,Mei Xiaomin²¹,Zou Guoping²¹,Yang Yuefeng²¹,Li Quanhao²¹,Tian Xiju²¹,Chen Hong²¹,Xiao Jialiang²¹,Song Xiaoming²¹,Li Guangning²¹,Li Guozhong²¹,Yang Chunjie²¹,Zhang Xiting²¹,Wang Chun²¹,Hu Jizheng²¹,Hu Wei²¹,Jiao Zhen²¹,Lu Yunnan²¹,Xia Zhangyong²¹,Wang Yufen²¹,Wang Yinshan²¹,Qi Jinxing²¹,Wang Xiaoping²¹,Liu Shuqin²¹,Li Bo²¹,Li Yinghui²¹,Sun Yaming²¹,Jing Ping²¹,Wu Jialing²¹,Yang Bo²¹,Zhang Jinghua²¹,Zhang Tianxia²¹,Zheng Chunling²¹,Li Lejun²¹,Li Huimin²¹,Yu Fumin²¹,Yao Shufang²¹,Chang Jianjun²¹,Li Dongqun²¹,Du Ganqin²¹,Zhao Yi²¹,Liang Pengfei²¹,Wang Ming²¹,Fang Qi²¹,Deng Youqing²¹,Gao Xuzhao²¹,Zhu Runxiu²¹,Xie Yimin²¹,Liu Yanshu²¹,Yuan Yi²¹,Wu Qiuyi²¹,Zhao Guimei²¹,Yang Yan²¹,Lu Yong²¹,Zhao Weidong²¹,Chen Tianbao²¹,Pan Deng²¹,Yang Min²¹,Xue Baoguo²¹,Zhang Ge²¹,Zhao Yanjiang²¹,Wei Yunfei²¹,Yun Wenwei²¹,Chen Xiaoqi²¹,Wu Danhong²¹,Zhang Lifang²¹,Sheng Baoying²¹,Cui Zhigang²¹,Xie Xiangdong²¹,Cheng Guanghui²¹,Zhang Yifei²¹,Zhu Ruiming²¹,Chen Yong²¹,Liu GuoHua²¹,Feng Lei²¹,Long Zhihua²¹,Chen Huisheng²¹,Zhang Ping²¹,Cui Yuanliang²¹,Zhang Yongli²¹,Han Yazhou²¹,Bai Yajie²¹,Tang Tieyu²¹,Wu Songdi²¹,Gong Wenping²¹,Wang Jun²¹,Zhu Zhishan²¹,Ma Xiaoyan²¹,Yao Leyi²¹,Li Runhui²¹,Zhu Shuanggen²¹,Li Juntao²¹,Qi Xiuhui²¹,Jiang Zhongping²¹,Liang Zhigang²¹,Liu Chunping²¹,Xu Dongjuan²¹,Qiu Tao²¹,Chen Chunping²¹,Tan Hong²¹,Chen Shengli²¹,Yang Chunshui²¹,Jun Wei²¹,He Qing²¹,Sun Zengqiang²¹,Li Shen²¹,Guo Cunju²¹,Wang Hongliang²¹,Li Dongfang²¹,Wu Hongbin²¹,Zhen Wenxu²¹,Wang Lijun²¹,Hong Wenke²¹,Qiu Xuerong²¹,Wei Xinxia²¹,Lv Yongtao²¹,Feng Xiangyang²¹,Yang Gaiqing²¹,Lin Songjun²¹,Cao Aihua²¹,Sun Dejin²¹,Fu Pengcheng²¹,Cao Cao²¹,Xue Wenjun²¹,Liu Haiyan²¹,Li Shanshan²¹,Qu Fang²¹,Zhou Zhengguo²¹,Liu Ping²¹,Wang Lixia²¹,Wu Yiping²¹,Liu Jinxing²¹,Sun Xin²¹,Wang Qingyong²¹,Li Xiaomei²¹,Wang Qizhang²¹,Wu Yongxiong²¹,Liu Chunfeng²¹,Zhao Yanxin²¹,Lin Zhijian²¹,Ma Rui²¹,Li Jiedan²¹,Zhu Zhishun²¹,Guo Lili²¹,Sun Bing²¹,Tan Jun²¹,Yang Ke²¹,Bi Yong²¹,Duan Yingjie²¹,Li Shaochun²¹,Lou Xiaoliang²¹,Huang Xiaosong²¹,Zang Fucai²¹,Dong Yonghua²¹,Zhao Jingyan²¹,Cui Yanzeng²¹,Zhang Zili²¹,Zhang Yali²¹,Yan Peng²¹,Fan Huixian²¹,Ji Qiuhong²¹,Wu Aisheng²¹,Han Xinshen²¹,Liu Li²¹,Song Jie²¹,Liu Shuting²¹,Che Xiaoyu²¹,Liang Xianhong²¹,Li Shangzhi²¹,Qi Nan²¹,Chen Xiaolei²¹,Liu Chenhui²¹,Pi Jingtao²¹,Tian Yu²¹,Wang Nan²¹,Li Zhengyang²¹,Luo Biyang²¹,Yue Fanfang²¹,Guo Lei²¹,Hu Kun²¹,Zhong Xi²¹,Lu Jiawei²¹,Wang Long²¹,Yu Jiandong²¹,Zhang Xiaowu²¹,Zhou Mengyuan²¹,Chen Yiyi²¹,Ji Zhiyuan²¹,Li Jianying²¹,Yan Hongyi²¹,Wang Mengxing²¹,Wu Haibo²¹

Affiliation:

1. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

2. China National Clinical Research Center for Neurological Diseases, Beijing, China

3. Department of Neurology, University of California, San Francisco

4. Department of Neurology and Stroke Center, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, INSERM LVTS-U1148, University of Paris, Paris, France

5. Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada

6. Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom

7. Department of Neurology, Weihai Wendeng District People’s Hospital, Weihai, China

8. Department of Neurology, Sui Chinese Medical Hospital, Shangqiu, China

9. Department of Neurology, Qinghe People’s Hospital, Xingtai, China

10. Department of Neurology, Biyang People’s Hospital, Zhumadian, China

11. Department of Neurology, Jiyuan Chinese Medical Hospital, Jiyuan, China

12. Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

13. Department of Neurology, The Affiliated Shuyang Hospital of Xuzhou Medical University, Shuyang Hospital, Suqian, China

14. Department of Neurology, Mengzhou People’s Hospital, Jiaozuo, China

15. Department of Neurology, Hejian People’s Hospital, Cangzhou, China

16. Department of Neurology, Xiuwu People’s Hospital, Jiaozuo, China

17. Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China

18. National Center for Neurological Disorders, Beijing, China

19. Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China

20. Chinese Institute for Brain Research, Beijing, China

21. for the INSPIRES Investigators

Abstract

ImportanceComparisons are limited for immediate-intensive and delayed-intensive statin for secondary stroke prevention and neuroprotection in patients with acute mild ischemic stroke or transient ischemic attack (TIA) from atherosclerosis.ObjectiveTo estimate whether immediate-intensive statin therapy is safe and can lower the risk of recurrent stroke compared with delayed-intensive statin in patients with acute mild ischemic stroke or high-risk TIA from atherosclerosis.Design, Setting, and ParticipantsThe Intensive Statin and Antiplatelet Therapy for High-Risk Intracranial or Extracranial Atherosclerosis (INSPIRES) trial, a double-blind, placebo-controlled, 2 × 2 factorial, randomized clinical trial enrolled patients from September 2018 to October 2022. The trial was conducted at 222 hospitals in China. Patients aged 35 to 80 years with mild ischemic stroke or high-risk TIA of presumed atherosclerosis within 72 hours of symptom onset were assessed.InterventionsPatients were randomly assigned to receive immediate-intensive atorvastatin (80 mg daily on days 1-21; 40 mg daily on days 22-90) or 3-day delayed treatment (placebo for days 1-3, followed by placebo and atorvastatin, 40 mg daily on days 4-21, and then atorvastatin, 40 mg daily on days 22-90).Main Outcomes and MeasuresThe primary efficacy outcome was new stroke within 90 days, and a secondary efficacy outcome was poor functional outcome. Moderate to severe bleeding was the primary safety outcome.ResultsA total of 11 431 patients were assessed for eligibility, and 6100 patients (median [IQR] age, 65 [57-71] years; 3915 men [64.2%]) were enrolled, with 3050 assigned to each treatment group. Within 90 days, new stroke occurred in 245 patients (8.1%) in the immediate-intensive statin group and 256 patients (8.4%) in the delayed group (hazard ratio, 0.95; 95% CI, 0.80-1.13). Poor functional outcome occurred in 299 patients (9.8%) and 348 patients (11.4%) in the immediate-intensive and delayed-intensive statin groups, respectively (odds ratio, 0.83; 95% CI, 0.71-0.98). Moderate to severe bleeding occurred in 23 of 3050 patients (0.8%) and 17 of 3050 patients (0.6%), in the immediate-intensive and delayed-intensive statin groups, respectively.Conclusions and RelevanceImmediate-intensive statin initiated within 72 hours did not reduce the risk of stroke within 90 days and may be associated with improved functional outcomes without significant difference in moderate to severe bleeding, compared with 3-day delayed-intensive statin in Chinese patients with acute mild ischemic stroke or TIA from atherosclerosis.Trial RegistrationClinicalTrials.gov Identifier: NCT03635749

Publisher

American Medical Association (AMA)

Link

https://jamanetwork.com/journals/jamaneurology/articlepdf/2819378/jamaneurology_gao_2024_oi_240028_1719343652.93257.pdf

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