Title:Effects of PCSK9 Inhibitors on Early Neurologic Deterioration in Patients with Acute Non-Cardioembolism without Hemorrhagic Transformation After Intravenous Thrombolysis
Volume: 21
Issue: 3
Author(s): Junjie Lei, Qian Fan, Xiaofeng Chen, Wenbin Li, Yanfang Peng, Yiming Cai, Xudong Liu, Chenhao Liu and Lei Zhang*
Affiliation:
- Department of Cerebrovascular Diseases, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 528406, China
Keywords:
PCSK9 inhibitor, acute ischemic stroke, cardioembolism, hemorrhagic transformation, early neurologic deterioration, thrombolysis.
Abstract:
Background: END (Early Neurologic Deterioration) significantly elevates the risk of
morbidity and mortality. While numerous studies have investigated END following hemorrhagic
transformation post-thrombolysis in acute cerebral infarction research on END without hemorrhagic
transformations in patients with acute cerebral infarction due to non-cardiogenic embolism remains
scarce.
Aim: This study aimed to elucidate the impact of PCSK9 inhibitors on early neurological deterioration
(END) in patients with acute non-cardioembolism cerebral infarction without hemorrhagic
transformation post-intravenous thrombolysis. Additionally it aimed to identify risk factors associated
with END in patients suffering from this type of stroke.
Objective: The objective of this study is to investigate the effect of PCSK9 inhibitors on early
neurologic deterioration (END) in patients with acute non-cardiogenic cerebral infarction without
hemorrhagic transformation after intravenous thrombolysis and identify associated risk factors for
END in this patient population.
Methods: In this retrospective case-control study the data of consecutive patients who underwent
intravenous thrombolysis after AIS (acute ischemic stroke) without hemorrhagic transformation
during hospitalization at the Stroke Center of The Fifth Affiliated Hospital of Sun Yat-sen University
between January 2018 to February 2023 were retrieved and assessed. An increase of >2 in the
National Institutes of Health Stroke Scale (NIHSS) within 7 days after admission was defined as
END.
Results: This study included 250 patients (56 males 22.4%) they were 63.344±12.901 years old.
There were 41 patients in the END group and 209 in the non-END group. The usage rate of PCSK9
inhibitors was significantly different between the END group and non-END group (29.268%
vs 58.852% P<0.001). The White blood cell count (WBC) and homocysteine levels showed a significant
difference between the two groups (all P<0.05). Patients not using PCSK9 inhibitors
(OR=0.282 95%CI: 0.127-0.593) and white blood cell count (OR=1.197, 95%CI: 1.085-1.325)
were independently associated with END. Receiver-operating characteristic curve analysis
suggested that the sensitivity specificity and area under the curve for PCSK9 inhibitors used for
END were 88.9%, 80.7% and 0.648 respectively.
Conclusion: The use of PCSK9 inhibitors can reduce the incidence of early neurological deterioration
in patients with acute non-cardioembolism and non-hemorrhagic transformation after intravenous
thrombolysis.
