Five-Year Prognosis After TIA or Minor Ischemic Stroke in Asian and Non-Asian Populations

• Published in: Neurology Vol. 96; no. 1; p. e54
• Main Authors: Hoshino, Takao, Uchiyama, Shinichiro, Wong, Lawrence K S, Kitagawa, Kazuo, Charles, Hugo, Labreuche, Julien, Lavallée, Philippa C, Albers, Gregory W, Caplan, Louis R, Donnan, Geoffrey A, Ferro, José M, Hennerici, Michael G, Molina, Carlos, Rothwell, Peter M, Steg, P Gabriel, Touboul, Pierre-Jean, Vicaut, Éric, Amarenco, Pierre
• Format: Journal Article
• Language: English
• Published: United States 05.01.2021
• Subjects: Aged; Asian Continental Ancestry Group; Cardiovascular Diseases - ethnology; Cardiovascular Diseases - etiology; Female; Humans; Ischemic Attack, Transient - complications; Ischemic Attack, Transient - ethnology; Ischemic Stroke - complications; Ischemic Stroke - ethnology; Male; Middle Aged; Prognosis
• ISSN: 1526-632X
• DOI: 10.1212/wnl.0000000000010995

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. 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. 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; = 0.41) and stroke (10.7% vs 8.5%; HR, 1.17; 95% CI, 0.90-1.51; = 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; = 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; = 0.020) and non-Asian (HR, 1.39; 95% CI, 1.02-1.90; = 0.037) patients. 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. 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.