Five-year prognosis after TIA or minor ischemic stroke in Asian and non-Asian countries. Neurology Hoshino, T., Uchiyama, S., Wong, L. K., Kitagawa, K., Charles, H., Labreuche, J., Lavallee, P. C., Albers, G. W., Caplan, L. R., Donnan, G. A., Ferro, J. M., Hennerici, M. G., Molina, C., Rothwell, P. M., Gabriel Steg, P., Touboul, P., Vicaut, E., Amarenco, P., TIA Investigators,, 2020


OBJECTIVE: We aimed to determine long-term vascular outcomes of Asian patients who experienced TIA or minor ischemic stroke and to compare the outcomes of Asians with those of non-Asians, in the context of modern guideline-based prevention strategies.METHODS: This is a sub-analysis of the 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, non-fatal stroke, and non-fatal 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% 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. Asians 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 Asians 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, Asians have a similar 5-year risk of cardiovascular death, stroke and acute coronary syndrome as non-Asians.

View details for DOI 10.1212/WNL.0000000000010995

View details for PubMedID 33046613