Non-cardioembolic stroke/transient ischaemic attack in Asians and non-Asians: A post-hoc analysis of the PERFORM study. (March 2019)

• Record Type: Journal Article
• Authors: Hoshino, Takao; Sissani, Leila; Labreuche, Julien; Bousser, Marie-Germaine; Chamorro, Angel; Fisher, Marc; Ford, Ian; Fox, Kim M; Hennerici, Michael G; Mattle, Heinrich P; Rothwell, Peter M; Gabriel Steg, Philippe; Vicaut, Eric; Amarenco, Pierre
• Is Part Of: European stroke journal. Volume 4:Number 1(2019)
• Page Start: 65
• Page End: 74
• Publication Date: 2019-03
• Subjects: Antiplatelet -- bleeding -- cerebrovascular disease -- intracranial haemorrhage -- race and ethnicity; Cerebrovascular disease -- Periodicals; 616.8005
• DOI: 10.1177/2396987318797245
• Languages: English
• ISSNs: 2396-9873

Abstract

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.