Cognitive outcome in acute simvastatin treatment for aneurysmal subarachnoid hemorrhage: A propensity matched analysis.
OBJECTIVE
Experimental evidence has indicated the benefit of simvastatin in the treatment of subarachnoid hemorrhage (SAH). Recently, acute simvastatin treatment was not shown to be beneficial in neurological outcome using modified Rankin Scale. Cognitive function is another important dimension of outcome assessment and yet had not been investigated in statin studies for aneurysmal subarachnoid hemorrhage. We therefore explored whether acute simvastatin treatment would improve cognitive outcomes.


METHODS
The study recruited SAH patients with acute simvastatin treatment enrolled in a randomized controlled double-blinded clinical trial (ClinicalTrials.gov Identifier: NCT01038193). A control cohort of SAH patients without simvastatin treatment was identified with propensity score matching of age and admission grade. Primary outcome measure was Montreal Cognitive Assessment (MoCA). Secondary outcome measures were delayed ischaemic deficit (DID), delayed cerebral infarction, modified Rankin Scale (mRS), and Mini-Mental State Examination (MMSE).


RESULTS
Fifty-one SAH patients with acute simvastatin treatment and 51 SAH patients without simvastatin treatment were recruited for analysis. At 3 months, there were no differences in MoCA scores (MoCA: 21+/-6 vs. 21+/-5, p=0.772). MoCA-assessed cognitive impairment (MoCA<26) was not different (75% vs. 80%, OR 0.7, 95%CI 0.3 to 1.8, p=0.477). There were also no differences in DID, delayed cerebral infarction, favorable mRS outcome, and MMSE scores, and MMSE-assessed cognitive impairment between both groups.


CONCLUSIONS
The current study does not support that acute simvastatin treatment improves cognitive outcome after aneurysmal subarachnoid hemorrhage.
Division of Neurosurgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong. Electronic address: georgewong@surgery.cuhk.edu.hk.
George K C
GK
Wong
Division of Neurology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Adrian
A
Wong
School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Beny C Y
BC
Zee
Division of Neurosurgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Wai S
WS
Poon
Department of Anesthesia and Intensive Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Matthew T V
MT
Chan
Department of Anesthesia and Intensive Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Tony
T
Gin
Department of Diagnostic Radiology, Kwong Wah Hospital, Hong Kong.
Deyond Y W
DY
Siu
Division of Neurology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Vincent C T
VC
Mok
D000368:Aged; D003072:Cognition Disorders / Q000188:drug therapy* / Q000209:etiology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D019821:Simvastatin / Q000008:administration & dosage / Q000494:pharmacology*; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019821:Simvastatin
Cognitive outcome; Mini-Mental State Examination; Montreal Cognitive Assessment; Propensity matched analysis; Simvastatin; Subarachnoid hemorrhage