title: Effect of serum lipid levels on stroke outcome after rt-PA therapy: SAMURAI rt-PA registry.
abstract: BACKGROUND
  The effects of lipid levels on clinical outcomes after ischemic stroke are controversial. Whether admission lipid levels and prior statin use are associated with early intracerebral hemorrhage (ICH) and long-term functional outcome after recombinant tissue plasminogen activator (rt-PA) therapy for stroke patients was investigated.
  
  
  METHODS
  Ischemic stroke patients who received intravenous rt-PA from a multicenter registry were studied. Lipid levels on admission, including total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, and triglyceride levels, as well as prior statin use, were assessed. The primary outcome was favorable outcome at 3 months corresponding to a modified Rankin Scale score ≤1. The secondary outcome was any or symptomatic ICH within the initial 36 h.
  
  
  RESULTS
  Of 489 enrolled patients (171 women, 70.8 ± 11.6 years old), 60 used statins prior to stroke, 93 developed ICH (19.0%), and 188 (38.4%) had a favorable 3-month outcome. Of the lipid levels, only the HDL-C level was an independent predictor of favorable outcome after multivariate adjustment for baseline characteristics (OR 1.95, 95% CI 1.10-3.47 per 1 mmol/l; p = 0.023) and after further adjustment for pretreatment radiological findings (OR 2.03, 95% CI 1.07-3.84; p = 0.029). For the 187 stroke patients without cardioembolism, the HDL-C level was more strongly associated with favorable outcome (OR 4.94, 95% CI 1.91-12.76 per 1 mmol/l; p = 0.001). There were no significant associations between ICH and any lipid levels. Prior statin use was not associated with outcomes.
  
  
  CONCLUSIONS
  The admission HDL-C level was associated with favorable outcome 3 months after intravenous rt-PA therapy in stroke patients without cardioembolism.
authors.affiliation: Department of Cerebrovascular Medicine, Cerebrovascular Center and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Makihara
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Okada
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Koga
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Shiokawa
authors.forename: Jyoji
authors.initials: J
authors.lastname: Nakagawara
authors.forename: Eisuke
authors.initials: E
authors.lastname: Furui
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamagami
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hasegawa
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
authors.forename: Satoshi
authors.initials: S
authors.lastname: Okuda
authors.forename: Masaki
authors.initials: M
authors.lastname: Naganuma
authors.forename: Kazunori
authors.initials: K
authors.lastname: Toyoda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002543:Cerebral Hemorrhage / Q000453:epidemiology*; D008076:Cholesterol, HDL / Q000097:blood; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000188:drug therapy*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D005343:Fibrinolytic Agents; D008055:Lipids; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator