Association of pre-admission statin use with clinical outcomes in aneurysmal subarachnoid hemorrhage: a multicenter, observational, real-world study

BackgroundSubarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms is a severe stroke subtype with a high mortality rate. Statins, noted for cholesterol-independent benefits, are being studied as potential treatments, but their effectiveness is debated. This study assesses the impact of pre-admission statin therapy on aneurysmal SAH outcomes.MethodsThis was a multicenter, observational, real-world study from May 2012 to May 2023 at four Chinese tertiary medical centers. Patients were divided into statin and control groups based on pre-admission statin use. The primary outcome was favorable outcome at 30 days, defined as a modified Rankin Scale (mRS) score of 0–2. Propensity score matching (PSM) was applied to balance baseline characteristics. The trial was registered with Chinese Clinical Trial Registry (ChiCTR2300079305).ResultsOut of 1,431 patients, 821 met the inclusion criteria (statin group: 367; control group: 454). After PSM, each group comprised 220 patients. Pre-admission statin was associated with a higher likelihood of favorable outcome at 30 days (before PSM: odds ratio [OR] 3.67, 95% confidence interval [CI] 2.46–5.47, p < 0.001; after PSM: OR 5.00, 95% CI 3.00–8.32, p < 0.001). Subgroup analysis of the primary outcome revealed significant interactions between pre-admission statin and low-density lipoprotein cholesterol (LDL-C) and alcohol consumption (Both P for interaction < 0.05). The benefit of statin at 30 days was more pronounced in patients with LDL-C < 3.4 mmol/L and non-drinkers.ConclusionPre-admission statin therapy was associated with improved prognosis at 30 days in patients with aneurysmal SAH, however this benefit could not extend to 90 days. The effect of statin appeared to vary according to baseline LDL-C levels and alcohol consumption. Further multicenter, international randomized controlled trials are warranted to confirm these findings.