Abstract 18201: The Association between HMG-CoA Reductase Inhibitor Use and Neurological Outcome Following Cardiac Arrest in Patients Treated with Therapeutic Hypothermia
Introduction: HMG-CoA reductase inhibitors (statins) are known to reduce both inflammation and oxidative stress - key components within the pathophysiologic cascade of anoxic brain injury and reperfusion injury.
Hypothesis: We hypothesized that patients (pts) treated with lipophilic statins prior to cardiac arrest have more favorable neurological outcomes post therapeutic hypothermia (TH) compared to pts not taking statins.
Methods: A retrospective analysis was performed on 257 consecutive pts treated with TH post cardiac arrest. Statin use was determined by outpatient medication reconciliation at admission. The Cerebral Performance Category (CPC) score was used to assess neurologic outcome at discharge. We used a logistic regression model to adjust for covariates including age, gender, obesity, CAD, HTN, bystander CPR, arrest time to ROSC and initial rhythm. The primary outcome of favorable neurologic function was defined as CPC score ≤2.
Results: The initial rhythm at arrest was VT/VF in 144 (58%) pts; 102 (40%) pts received bystander CPR. The mean arrest to ROSC time was 24 (± 17) min and the mean age was 58 (±15) yrs. At discharge, 94 (36.5%) pts were CPC ≤2; 160 (63.5%) were CPC ≥3. Eighty-two (32%) pts were treated with statins pre-arrest, of which 64 (78%) were lipophilic. We found no significant association with prior statin use and favorable neurological outcome (OR 0.78: 95% CI 0.40 -1.53). We observed similar results in pts treated with lipophilic statins (OR 0.61: 95% CI 0.29 - 1.26).
Conclusions: In our analysis, statin use, and specifically lipophilic statins, prior to cardiac arrest was not associated with improved neurological outcomes post-TH. The pleiotropic effects of statins do not appear to mitigate neurological injury post cardiac arrest. Further investigation is needed to determine potential adjuvants to TH in cardiac arrest pts to improve neurologic outcomes.
Author Disclosures: B. Holmes: None. N. Borges: None. K. Mandsager: None. Y. Song: None. M. Young: None. J. McPherson: None.
- © 2014 by American Heart Association, Inc.