Objective It is uncertain if patients with cardioembolic stroke and absence of a guidance-based indication for statin therapy should be administered a statin for prevention of subsequent vascular events. This study was performed to determine whether the statin therapy is beneficial to prevent major vascular events in this population.

Methods Using a prospective multicenter stroke registry database, we identified acute cardioembolic stroke patients who were hospitalized between 2008 and 2015. Patients who had other established indications for statin therapy according to current guideline were excluded. Major vascular event was defined as a composite of stroke recurrence, myocardial infarction and vascular death. We performed frailty model analysis with the robust sandwich variance estimator using the stabilized inverse probability of treatment weighting method to estimate hazard ratios of statin therapy on outcomes.

Results Of 6,124 cardioembolic stroke patients, 2,888 (male, 44.6%; mean age, 75.3 years with 95% confidence interval 74.8-75.8) were eligible; and 1,863 (64.5%) were on statin therapy during hospitalization. After a median follow-up of 359 days, cumulative incidences of major vascular events were 9.3% in the statin users and 20.5% in the non-users (p <0.001 by log-rank test). The adjusted hazard ratios of statin therapy was 0.39 (95% confidence interval, 0.31-0.48) for major vascular events; 0.81 (0.57-1.16) for stroke recurrence; 0.28 (0.21-0.36) for vascular death; and 0.53 (0.45-0.61) for all-cause death, respectively.

Conclusion Starting statin during acute stage of ischemic stroke may reduce the risk of major vascular events, vascular death and all-cause death in cardioembolic stroke patients with no guidance-based indication for statin.

This retrospective observational study was based on a prospective, nationwide, multicenter, web-based acute stroke registry (Clinical Research Collaboration for Stroke in Korea, CRCS-K) of consecutive acute ischemic stroke or TIA patients admitted to 15 academic or regional stroke centers in Korea. Among a total of 30,656 patients registered in the CRCS-K registry database between April 2008 and March 2015, 26,880 acute ischemic stroke or TIA patients were hospitalized at the participating centers within 7 days from their symptom onset. Among these patients, 6,124 patients were classified as CES according to a modified Trial of Org 10172 in Acute Stroke Treatment classification system.