Differences in Characteristics and Outcomes between Asian and Non-Asian Patients in the TIAregistry.org

Takao Hoshino, Shinichiro Uchiyama, Lawrence K.S. Wong, Leila Sissani, Gregory W. Albers, Natan M. Bornstein, Louis R. Caplan, Geoffrey A. Donnan, José M. Ferro, Michael G. Hennerici, Julien Labreuche, Philippa C. Lavallée, Carlos Molina, Peter M. Rothwell, Philippe Gabriel Steg, Pierre Jean Touboul, Éric Vicaut, Pierre Amarenco*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Background and Purpose - This study provides the contemporary causes and prognosis of transient ischemic attack (TIA) and minor stroke in Asians and the direct comparisons with non-Asians. Methods - The TIAregistry.org enrolled 4789 patients (1149 Asians and 3640 non-Asians) with a TIA or minor ischemic stroke within 7 days of onset. Every participating facility had systems dedicated to urgent intervention of TIA/stroke patients by specialists. The primary outcome was a composite of cardiovascular death, nonfatal stroke, and nonfatal acute coronary syndrome. Results - Approximately 80% of patients were evaluated within 24 hours of symptom onset. At 1 year, there were no differences in the rates of composite cardiovascular events (6.8% versus 6.0%; P=0.38) and stroke (6.0% versus 4.8%; P=0.11) between Asians and non-Asians. Asians had a lower risk of cerebrovascular disease (stroke or TIA) than non-Asians (adjusted hazard ratio, 0.79; 95% confidence interval, 0.63-0.98; P=0.03); the difference was primarily driven by a lower rate of TIA in Asians (4.2% versus 8.3%; P<0.001). Moderately severe bleeding was more frequent in Asians (0.8% versus 0.3%; P=0.02). In multivariable analysis, multiple acute infarcts (P=0.005) and alcohol consumption (P=0.02) were independent predictors of stroke recurrence in Asians, whereas intracranial stenosis (P<0.001), ABCD 2 score (P<0.001), atrial fibrillation (P=0.008), extracranial stenosis (P=0.03), and previous stroke or TIA (P=0.03) were independent predictors in non-Asians. Conclusions - The short-term stroke risk after a TIA or minor stroke was lower than expected when urgent evidence-based care was delivered, irrespective of race/ethnicity or region. However, the predictors of stroke were different for Asians and non-Asians.

Original languageEnglish
Pages (from-to)1779-1787
Number of pages9
JournalStroke
Volume48
Issue number7
DOIs
StatePublished - 1 Jul 2017
Externally publishedYes

Funding

FundersFunder number
Horizon 2020 Framework Programme692340

    Keywords

    • ischemic stroke
    • population
    • prognosis
    • race and ethnicity
    • transient ischemic attack

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