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Non-cardioembolic stroke/transient ischemic attack in Asians and non-Asians: a post-hoc analysis of the PERFORM Study

European Stroke Organisation 2018. The final, definitive version of this paper has been published in Hoshino, T., Sissani, L., Labreuche, J., Bousser, M.-G., Chamorro, A., Fisher, M., … Amarenco, P. (2019). Non-cardioembolic stroke/transient ischaemic attack in Asians and non-Asians: A post-hoc analysis of the PERFORM study. European Stroke Journal, 4(1), 65–74 by Sage Publications Ltd. All rights reserved. It is available at: https://doi.org/10.1177/2396987318797245 . ;ISSN: 0039-2499 ;EISSN: 1524-4628

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  • Title:
    Non-cardioembolic stroke/transient ischemic attack in Asians and non-Asians: a post-hoc analysis of the PERFORM Study
  • Author: Hoshino, T ; Sissani, L ; Labreche, J ; Bousser, M-G ; Chamorro, A ; Fisher, M ; Ford, I ; Fox, K ; Hennerici, M ; Rothwell, P ; Steg, PG ; Vicaut, E ; Amarenco, P
  • Subjects: Antiplatelet ; ASPIRIN ; ATHEROSCLEROSIS ; bleeding ; BLOOD-PRESSURE ; BURDEN ; CARDIOVASCULAR-DISEASE ; cerebrovascular disease ; CHINESE ; Clinical Neurology ; intracranial haemorrhage ; Life Sciences & Biomedicine ; Neurosciences & Neurology ; race and ethnicity ; RISK-FACTORS ; Science & Technology ; STROKE ; SUBTYPES
  • Description: Introduction We aimed to compare the characteristics and vascular outcomes between Asian and non-Asian patients with non-cardioembolic stroke/transient ischaemic attack receiving antiplatelet monotherapy and to identify population-specific predictors for recurrent events. Patients and methods We conducted a post-hoc analysis of data from the PERFORM study, in which 19,100 patients (mean age, 67.2 years; male, 63%; 2178 Asian and 16,922 non-Asian patients) with non-cardioembolic ischaemic stroke/transient ischaemic attack were randomised to aspirin or terutroban and followed for two years. The primary outcome was a composite of major adverse cardiovascular events (non-fatal myocardial infarction, non-fatal stroke and cardiovascular death). Results There was no difference in major adverse cardiovascular events risk between Asian and non-Asian populations (11.1% vs. 10.5%; p = 0.39). However, Asian patients were at significantly higher risk of intracranial haemorrhage (2.4% vs. 1.3%; hazard ratio (HR) 1.87; 95% confidence interval (CI) 1.34–2.60; p < 0.001) and major bleeding (5.4% vs. 4.1%; HR 1.30; 95% CI 1.04–1.61; p = 0.02). Stroke risk was significantly higher in Asian than in non-Asian populations among patients with lacunar stroke (7.4% vs. 4.5%; p = 0.02). In multivariable analysis, diastolic blood pressure (HR per 5 mm Hg 1.08; 95% CI 1.01–1.16; p = 0.03) and diabetes (HR 1.36; 95% CI 1.22–1.52; p < 0.001) were independent predictors of major adverse cardiovascular events for Asian and non-Asian patients, respectively. Conclusion: Compared with non-Asian patients, Asian patients had significantly higher risk of haemorrhagic events when given antiplatelet monotherapy for secondary prevention after non-cardioembolic stroke/transient ischaemic attack. Lacunar stroke and elevated diastolic blood pressure were more associated with recurrence risk in Asian patients.
  • Publisher: SAGE Publications
  • Creation Date: 2018-06
  • Language: English
  • Identifier: ISSN: 0039-2499
    EISSN: 1524-4628
  • Source: Spiral
    Alma/SFX Local Collection
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