U-shaped association between low-density lipoprotein cholesterol levels and risk of futile reperfusion mediated by stroke-associated pneumonia in acute ischemic stroke after endovascular thrombectomy.
Clin Neurol Neurosurg
; 243: 108399, 2024 Aug.
Article
in En
| MEDLINE
| ID: mdl-38901376
ABSTRACT
OBJECTIVE:
Futile reperfusion (FR) is becoming a major challenge in the treatment of patients with acute ischaemic stroke (AIS) undergoing endovascular thrombectomy. This study aims to determine the dose-response relationship between low-density lipoprotein cholesterol (LDL-C) levels and the risk of FR in patients with AIS undergoing endovascular thrombectomy and to investigate potential mediators.METHODS:
A total of 614 patients with AIS undergoing endovascular thrombectomy were enrolled and divided into five groups according to quintiles of LDL-C levels Q1(≤2.27â¯mmol/l), Q2 (2.27-2.5â¯mmol/l), Q3 (2.5-2.59â¯mmol/l), Q4 (2.59-2.97â¯mmol/l) and Q5 (≥2.97â¯mmol/l). Associations between LDL-C levels and the risk of FR and stroke-associated pneumonia (SAP) were estimated using multivariate logistic regression models. Restricted cubic spline curves were used to describe the dose-response relationship between LDL-C levels and the risk of FR and SAP. Mediation effect analysis was performed in R software with 100 bootstrap samples.RESULTS:
After adjustment for confounders, both low and high LDL-C levels were significantly associated with a higher risk of FR compared with the reference group (Q3). We observed a U-shaped association between LDL-C levels and the risk of FR (P for nonlinear =0.012). Mediation analysis showed that the association between LDL-C levels and the risk of FR was 29.7â¯% (95â¯% CI 2.96â¯%-75.0â¯%, P=0.02) mediated by SAP.CONCLUSIONS:
We found a U-shaped association between LDL-C levels and the risk of FR that was mediated by SAP. Clinicians should note that in AIS patients undergoing endovascular thrombectomy, lower LDL-C levels are not always better.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Pneumonia
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Thrombectomy
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Endovascular Procedures
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Ischemic Stroke
/
Cholesterol, LDL
Limits:
Aged
/
Aged80
/
Female
/
Humans
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Male
/
Middle aged
Language:
En
Journal:
Clin Neurol Neurosurg
Year:
2024
Document type:
Article