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; TIAregistry.org Investigators

doi:10.1161/STROKEAHA.117.016874

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

Stroke. 2017 Jul;48(7):1779-1787. doi: 10.1161/STROKEAHA.117.016874. Epub 2017 Jun 5.

Authors

Takao Hoshino¹, Shinichiro Uchiyama¹, Lawrence K S Wong¹, Leila Sissani¹, Gregory W Albers¹, Natan M Bornstein¹, Louis R Caplan¹, Geoffrey A Donnan¹, José M Ferro¹, Michael G Hennerici¹, Julien Labreuche¹, Philippa C Lavallée¹, Carlos Molina¹, Peter M Rothwell¹, Philippe Gabriel Steg¹, Pierre-Jean Touboul¹, Éric Vicaut¹, Pierre Amarenco²; TIAregistry.org Investigators

Affiliations

¹ From the APHP, Department of Neurology and Stroke Center, Bichat Hospital, INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, France (T.H., L.S., P.C.L., P-J.T., P.A.); Clinical Research Center for Medicine, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo, Japan (S.U.); Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital (L.K.S.W.); Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA (G.W.A.); Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Israel (N.M.B.); Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (L.R.C.); The Florey Institute of Neuroscience and Mental Health, the University of Melbourne, Parkville, VIC, Australia (G.A.D.); Department of Neurosciences, Hospital Santa Maria, University of Lisbon, Portugal (J.M.F.); Department of Neurology, Universitäts Medizin Mannheim, Heidelberg, Germany (M.G.H.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, France (J.L.); Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Spain (C.M.); Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, United Kingdom (P.M.R.); APHP, Department of Cardiology, INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, Hôpital Bichat, France, and NHLI Imperial College, ICMS Royal Brompton Hospital, London, United Kingdom (P.G.S.); APHP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, France (É.V.).
² From the APHP, Department of Neurology and Stroke Center, Bichat Hospital, INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, France (T.H., L.S., P.C.L., P-J.T., P.A.); Clinical Research Center for Medicine, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo, Japan (S.U.); Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital (L.K.S.W.); Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA (G.W.A.); Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Israel (N.M.B.); Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (L.R.C.); The Florey Institute of Neuroscience and Mental Health, the University of Melbourne, Parkville, VIC, Australia (G.A.D.); Department of Neurosciences, Hospital Santa Maria, University of Lisbon, Portugal (J.M.F.); Department of Neurology, Universitäts Medizin Mannheim, Heidelberg, Germany (M.G.H.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, France (J.L.); Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Spain (C.M.); Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, United Kingdom (P.M.R.); APHP, Department of Cardiology, INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, Hôpital Bichat, France, and NHLI Imperial College, ICMS Royal Brompton Hospital, London, United Kingdom (P.G.S.); APHP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, France (É.V.). pierre.amarenco@aphp.fr.

PMID: 28584002
DOI: 10.1161/STROKEAHA.117.016874

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), ABCD² 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.

Keywords: ischemic stroke; population; prognosis; race and ethnicity; transient ischemic attack.

Publication types

Comparative Study
Observational Study

MeSH terms

Aged
Aged, 80 and over
Asian People / ethnology*
Asian People / genetics
Female
Follow-Up Studies
Humans
Internationality*
Ischemic Attack, Transient / diagnosis
Ischemic Attack, Transient / ethnology*
Ischemic Attack, Transient / genetics
Male
Middle Aged
Prospective Studies
Registries*
Stroke / diagnosis
Stroke / ethnology*
Stroke / genetics
Treatment Outcome