gms | German Medical Science

Objective: Being proved in several animal SAH models, the efficacy of statin treatment in aneurysmal subarachnoid hemorrhage, remains controversial. Multiple studies, meta-analyses inclusively, indicated that the use of statins significantly decreases the occurrence of cerebral vasospasm (CVS) in aneurysmal SAH patients, whereas the incidence of delayed cerebral infarction (DCI), delayed ischemic neurological deficit (DIND) and favorable outcome were not affected. Considering this discrepancy, we aimed to investigate the effects of statin treatment in non-aneurysmal SAH (naSAH) in accordance with research data of animal SAH blood injection models representing the pathophysiology of naSAH.

Methods: We retrospectively analyzed our institutional database of consecutive patients suffering naSAH between 1999-2015. All parameters relevant to this analysis, including statin-pretreatment, statin-posttreatment after SAH onset (drug: simvastatin 40mg a day), the occurrence of CVS, DCI (CVS-related vs. nonCVS-related), DIND and finally clinical outcome (mRS after 6 months; favorable outcome mRS 0-2 vs. unfavorable outcome mRS 3-6) in patients with non-aneurysmal SAH, were recorded.

Results: A total of 257 patients with naSAH were included. 37 (14%) naSAH patients with simvastatin treatment were recruited for analysis, including 22 (59%) patients with pretreatment and 15 (41%) patients with posttreatment after SAH onset. In total 54 patients (21%) developed CVS and 37 patients (14%) suffered from DCI. Patients under simvastatin treatment were not affected by a significantly lower risk of CVS (7/54, 13%; p>0,05), and DCI (7/37, 19%; p>0,05). Additionally, we differentiated between CVS-related (15/37, 41%) and non-CVS-related (22/37, 59%) DCI describing a trend towards lower risk of non-CVS-related DCI (6/22, 27%; p=0,2) in patients with simvastatin treatment. Furthermore, our results did not indicate a significant association between simvastatin treatment and favorable neurological outcome (30/217, 14%; p>0,05), and decrease on the occurrence of DIND (5/30, 17%; p>0,05). A relevant statistical difference between simvastatin-pretreatment and -postSAH-treatment was not detected either.

Conclusion: Contrary to studies in aneurysmal SAH patients, there is no significant effect of statin treatment proved in the current study on occurrence of CVS in case of non-aneurysmal SAH. Furthermore, the incidence of DCI, DIND and favorable clinical outcome were not affected by statin treatment in patients with naSAH.