β-Blockers, Pneumonia, and Outcome After Ischemic Stroke: Evidence From Virtual International Stroke Trials Archive

Marek Sykora; Pavel Siarnik; Jennifer Diedler; VISTA Acute Collaborators

doi:10.1161/STROKEAHA.114.008260

β-Blockers, Pneumonia, and Outcome After Ischemic Stroke: Evidence From Virtual International Stroke Trials Archive

Stroke. 2015 May;46(5):1269-74. doi: 10.1161/STROKEAHA.114.008260. Epub 2015 Apr 21.

Authors

Marek Sykora¹, Pavel Siarnik², Jennifer Diedler²; VISTA Acute Collaborators

Collaborators

VISTA Acute Collaborators:
K R Lees, A Alexandrov, P M Bath, E Bluhmki, N Bornstein, L Claesson, S M Davis, G Donnan, H C Diener, M Fisher, M Ginsberg, B Gregson, J Grotta, W Hacke, M G Hennerici, M Hommel, M Kaste, P Lyden, J Marler, K Muir, R Sacco, A Shuaib, P Teal, N G Wahlgren, S Warach, C Weimar

Affiliations

¹ From the Department of Neurology, University of Heidelberg, Heidelberg, Germany (M.S., J.D.); Department of Neurology, Comenius University, Bratislava, Slovakia (P.S.); and Department of Neurology, University of Tübingen, Tübingen, Germany (J.D.). mareksykora@med.uni-heidelberg.de.
² From the Department of Neurology, University of Heidelberg, Heidelberg, Germany (M.S., J.D.); Department of Neurology, Comenius University, Bratislava, Slovakia (P.S.); and Department of Neurology, University of Tübingen, Tübingen, Germany (J.D.).

PMID: 25899243
DOI: 10.1161/STROKEAHA.114.008260

Abstract

Background and purpose: Increased sympathetic drive after stroke is involved in the pathophysiology of several complications including poststroke immunudepression. β-Blocker (BB) therapy has been suggested to have neuroprotective properties and to decrease infectious complications after stroke. We aimed to examine the effects of random pre- and on-stroke BB exposure on mortality, functional outcome, and occurrence of pneumonia after ischemic stroke.

Methods: Data including standard demographic and clinical variables as well as prestroke and on-stroke antihypertensive medication, incidence of pneumonia, functional outcome defined using modified Rankin Scale and mortality at 3 months were extracted from the Virtual International Stroke Trials Archive. For statistical analysis multivariable Poisson regression was used.

Results: In total, 5212 patients were analyzed. A total of 1155 (22.2%) patients were treated with BB before stroke onset and 244 (4.7%) patients were newly started with BB in the acute phase of stroke. Mortality was 17.5%, favorable outcome (defined as modified Rankin Scale, 0-2) occurred in 58.2% and pneumonia in 8.2% of patients. Prestroke BB showed no association with mortality. On-stroke BB was associated with reduced mortality (adjusted risk ratio, 0.63; 95% confidence interval, 0.42-0.96). Neither prestroke BB nor on-stroke BB showed an association with functional outcome. Both prestroke and on-stroke BB were associated with reduced frequency of pneumonia (adjusted risk ratio, 0.77; 95% confidence interval, 0.6-0.98 and risk ratio, 0.49; 95% confidence interval, 0.25-0.95).

Conclusions: In this large nonrandomized comparison, on-stroke BB was associated with reduced mortality. Prestroke and on-stroke BB were inversely associated with incidence of nosocomial pneumonia. Randomized trials investigating the potential of β-blockade in acute stroke may be warranted.

Keywords: autonomic nervous system; beta-blockers, androgenic; infection; mortality; outcome assessment; pneumonia; stroke.

MeSH terms

Adrenergic beta-Antagonists / therapeutic use*
Adult
Aged
Aged, 80 and over
Archives
Brain Ischemia / complications*
Brain Ischemia / mortality
Brain Ischemia / therapy*
Female
Humans
Male
Middle Aged
Neuroprotective Agents / therapeutic use*
Pneumonia / complications*
Pneumonia / mortality
Stroke / complications*
Stroke / mortality
Stroke / therapy*
Treatment Outcome
Young Adult

Substances

Adrenergic beta-Antagonists
Neuroprotective Agents