Takao Hoshino1, Shinichiro Uchiyama1, Lawrence K S Wong1, Kazuo Kitagawa1, Hugo Charles1, Julien Labreuche1, Philippa C Lavallée1, Gregory W Albers1, Louis R Caplan1, Geoffrey A Donnan1, José M Ferro1, Michael G Hennerici1, Carlos Molina1, Peter M Rothwell1, P Gabriel Steg1, Pierre-Jean Touboul1, Éric Vicaut1, Pierre Amarenco2. 1. From the Department of Neurology and Stroke Center (T.H., H.C., J.L., P.C.L., P.-J.T., P.A.), Bichat Hospital, AP-HP and INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, France; Center for Brain and Cerebral Vessels (S.U.), Sanno Hospital and Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan; Department of Medicine and Therapeutics (L.K.S.W.), Chinese University of Hong Kong, Prince of Wales Hospital; Department of Neurology (T.H., K.K.), Tokyo Women's Medical University, Japan; Université Lille (J.L.), Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France; Stanford Stroke Center (G.W.A.), Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA; Cerebrovascular Disease Service (L.R.C.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA; Melbourne Brain Centre (G.A.D.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurosciences (J.M.F.), Service of Neurology, Hospital Santa Maria, University of Lisbon, Portugal; Department of Neurology (M.G.H.), Universitäts Medizin Mannheim, Heidelberg University, Germany; Stroke Unit, Department of Neurology (C.M.), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neuroscience, University of Oxford, UK; Department of Cardiology (P.G.S.), Bichat Hospital, AP-HP, Paris, France; National Heart and Lung Institute Imperial College (P.G.S.), Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London, UK; Department of Biostatistics (É.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, AP-HP, Paris, France. 2. From the Department of Neurology and Stroke Center (T.H., H.C., J.L., P.C.L., P.-J.T., P.A.), Bichat Hospital, AP-HP and INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, France; Center for Brain and Cerebral Vessels (S.U.), Sanno Hospital and Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan; Department of Medicine and Therapeutics (L.K.S.W.), Chinese University of Hong Kong, Prince of Wales Hospital; Department of Neurology (T.H., K.K.), Tokyo Women's Medical University, Japan; Université Lille (J.L.), Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France; Stanford Stroke Center (G.W.A.), Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA; Cerebrovascular Disease Service (L.R.C.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA; Melbourne Brain Centre (G.A.D.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurosciences (J.M.F.), Service of Neurology, Hospital Santa Maria, University of Lisbon, Portugal; Department of Neurology (M.G.H.), Universitäts Medizin Mannheim, Heidelberg University, Germany; Stroke Unit, Department of Neurology (C.M.), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neuroscience, University of Oxford, UK; Department of Cardiology (P.G.S.), Bichat Hospital, AP-HP, Paris, France; National Heart and Lung Institute Imperial College (P.G.S.), Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London, UK; Department of Biostatistics (É.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, AP-HP, Paris, France. pierre.amarenco@aphp.fr.
Abstract
OBJECTIVE: To determine long-term vascular outcomes of Asian patients who experienced TIA or minor ischemic stroke and to compare the outcomes of Asian patients with those of non-Asian patients, in the context of modern guideline-based prevention strategies. METHODS: This is a subanalysis of the TIAregistry.org project, in which 3,847 patients (882 from Asian and 2,965 from non-Asian countries) with a recent TIA or minor ischemic stroke were assessed and treated by specialists at 42 dedicated units from 14 countries and followed for 5 years. The primary outcome was a composite of cardiovascular death, nonfatal stroke, and nonfatal acute coronary syndrome. RESULTS: No differences were observed in the 5-year risk of the primary outcome (14.0% vs 11.7%; hazard ratio [HR], 1.10; 95% confidence interval [CI], 0.88-1.37; p = 0.41) and stroke (10.7% vs 8.5%; HR, 1.17; 95% CI, 0.90-1.51; p = 0.24) between Asian and non-Asian patients. Asian participants were at higher risk of intracranial hemorrhage (1.8% vs 0.8%; HR, 2.23; 95% CI, 1.09-4.57; p = 0.029). Multivariable analysis showed that the presence of multiple acute infarctions on initial brain imaging was an independent predictor of primary outcome and modified Rankin Scale score of >1 in both Asian (HR, 1.91; 95% CI, 1.11-3.29; p = 0.020) and non-Asian (HR, 1.39; 95% CI, 1.02-1.90; p = 0.037) patients. CONCLUSION: The long-term risk of vascular events in Asian patients was as low as that in non-Asian patients, while Asian participants had a 2.2-fold higher intracranial hemorrhage risk. Multiple acute infarctions were independently associated with future disability in both groups. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that among people who experienced TIA or minor stroke, Asian patients have a similar 5-year risk of cardiovascular death, stroke, and acute coronary syndrome as non-Asian patients.
OBJECTIVE: To determine long-term vascular outcomes of Asian patients who experienced TIA or minor ischemic stroke and to compare the outcomes of Asian patients with those of non-Asian patients, in the context of modern guideline-based prevention strategies. METHODS: This is a subanalysis of the TIAregistry.org project, in which 3,847 patients (882 from Asian and 2,965 from non-Asian countries) with a recent TIA or minor ischemic stroke were assessed and treated by specialists at 42 dedicated units from 14 countries and followed for 5 years. The primary outcome was a composite of cardiovascular death, nonfatal stroke, and nonfatal acute coronary syndrome. RESULTS: No differences were observed in the 5-year risk of the primary outcome (14.0% vs 11.7%; hazard ratio [HR], 1.10; 95% confidence interval [CI], 0.88-1.37; p = 0.41) and stroke (10.7% vs 8.5%; HR, 1.17; 95% CI, 0.90-1.51; p = 0.24) between Asian and non-Asian patients. Asian participants were at higher risk of intracranial hemorrhage (1.8% vs 0.8%; HR, 2.23; 95% CI, 1.09-4.57; p = 0.029). Multivariable analysis showed that the presence of multiple acute infarctions on initial brain imaging was an independent predictor of primary outcome and modified Rankin Scale score of >1 in both Asian (HR, 1.91; 95% CI, 1.11-3.29; p = 0.020) and non-Asian (HR, 1.39; 95% CI, 1.02-1.90; p = 0.037) patients. CONCLUSION: The long-term risk of vascular events in Asian patients was as low as that in non-Asian patients, while Asian participants had a 2.2-fold higher intracranial hemorrhage risk. Multiple acute infarctions were independently associated with future disability in both groups. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that among people who experienced TIA or minor stroke, Asian patients have a similar 5-year risk of cardiovascular death, stroke, and acute coronary syndrome as non-Asian patients.