BACKGROUND

Stroke is a leading cause of disability and death in advanced heart failure patients supported with a continuous-flow left ventricular assist system (CF-LVAS). Statins (HMG-CoA reductase inhibitors) reduce the risk of major cardiovascular and neurological events such as stroke, but their impact has not been evaluated in patients implanted with a CF-LVAS. We sought to explore the association between use of statin therapy and subsequent occurrence of neurological events, particularly stroke, following CF-LVAS implantation.

METHODS

We performed a single center, retrospective, observational cohort study in 200 consecutive adults implanted with a durable CF-LVAS over a 10-year period (2008-2018). We compared patients according to statin use following pump implantation, stratified by an exploratory analysis of pump type (HeartMate II, HeartWare HVAD, and HeartMate 3 [HM3] LVAS).

RESULTS

Overall, 24% of CF-LVAS recipients developed at least 1 neurological event, at a rate of 0.11 events per patient-year (EPPY) among those prescribed statins and 0.22 EPPY among non-users (age-adjusted hazard ratio [HR] 0.46; 95% confidence interval [CI],0.24–0.88; p = 0.019). In the cohort without the HM3 pump, ischemic strokes were 62% lower among statin users (0.05 versus 0.12 EPPY for non-users; age-adjusted HR, 0.38; 95% CI, 0.15–0.99; p = 0.048). The risk of ischemic stroke did not differ significantly when HM3 recipients were included in the analysis (age-adjusted HR, 0.51; 95% CI, 0.22–1.21; p = 0.13). However, ischemic stroke rate in HM3 LVAS recipients was similar to the rate in statin users who received a non-HM3 LVAS (0.06 and 0.05 EPPY, respectively). Rates of hemorrhagic stroke and other safety end points were not significantly different according to statin use.

CONCLUSION

Statin prescription following CF-LVAS is associated with lower rates of neurological events, driven predominantly by a reduction in ischemic strokes. These findings suggest that most patients with a pre-existing indication for statin therapy may continue using statins following CF-LVAS in an effort to decrease the incidence of ischemic stroke.

中文翻译：

---

他汀类药物治疗对晚期心力衰竭左心室辅助系统植入后神经系统事件的影响。

背景

中风是患有持续性左心室辅助系统（CF-LVAS）支持的晚期心力衰竭患者致残和死亡的主要原因。他汀类药物（HMG-CoA还原酶抑制剂）可降低发生重大心血管和神经系统事件（如中风）的风险，但尚未对其植入CF-LVAS的患者的影响进行评估。我们试图探讨他汀类药物治疗与CF-LVAS植入后神经系统事件（尤其是中风）的后续发生之间的关联。

方法

我们在10年期间（2008-2018年）对200名连续植入了耐用CF-LVAS的成年人进行了一项单中心，回顾性，观察性队列研究。我们根据泵植入后他汀类药物的使用情况对患者进行了比较，通过对泵类型（HeartMate II，HeartWare HVAD和HeartMate 3 [HM3] LVAS）的探索性分析进行分层。

结果

总体上，有24％的CF-LVAS接受者发生了至少1次神经系统事件，在这些处方他汀类药物中每患者年（EPPY）为0.11事件，非使用者中为0.22 EPPY（年龄调整后的危险比[HR] 0.46 ； 95％置信区间[CI]，0.24-0.88；p  = 0.019）。在没有HM3泵的队列中，他汀类药物使用者的缺血性卒中降低62％（非使用者为0.05 vs 0.12 EPPY；年龄校正后的HR为0.38； 95％CI为0.15-0.99；p  = 0.048）。当分析中包括HM3受体时，缺血性中风的风险没有显着差异（年龄调整后的HR，0.51； 95％CI，0.22-1.21；p = 0.13）。但是，HM3 LVAS接受者的缺血性卒中发生率与接受非HM3 LVAS的他汀类药物接受者的发生率相似（分别为0.06和0.05 EPPY）。根据他汀类药物的使用，出血性中风的发生率和其他安全终点没有显着差异。

结论

CF-LVAS后的他汀类药物处方与较低的神经系统事件发生率有关，这主要是由缺血性卒中的减少所致。这些发现表明，大多数已有他汀类药物治疗适应症的患者可在CF-LVAS后继续使用他汀类药物，以减少缺血性中风的发生。