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  • Jing, Jing  (6)
  • Wang, Anxin  (6)
  • Zuo, Yingting  (6)
  • English  (6)
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  • English  (6)
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  • 1
    Online Resource
    Online Resource
    Imaging Parameters Predict Recurrence After Transient Ischemic Attack or Minor Stroke Stratified by ABCD 2 Score
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. 6 ( 2021-06), p. 2007-2015
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. 6 ( 2021-06), p. 2007-2015
    Abstract: Whether imaging parameters would independently predict stroke recurrence in low-risk minor ischemic stroke (MIS) or transient ischemic attack (TIA) according to traditional score system (such as ABCD 2 score, which was termed on the basis of the initials of the five factors: age, blood pressure, clinical features, duration, diabetes) remains unclear. We sought to evaluate the association between imaging parameters and 1-year stroke recurrence in patients with TIA or MIS in different risk stratum stratified by ABCD 2 score. Methods: We included patients with TIA and MIS (National Institutes of Health Stroke Scale score ≤3) with complete baseline vessel and brain imaging data from the Third China National Stroke Registry III. Patients were categorized into different risk groups based on ABCD 2 score (low risk, 0–3; moderate risk, 4–5; and high risk, 6–7). The primary outcome was stroke recurrence within 1 year. Multivariable Cox proportional-hazards regression models were used to assess whether imaging parameters (large artery stenosis, infarction number) were independently associated with stroke recurrence. Results: Of the 7140 patients included, 584 patients experienced stroke recurrence within 1 year. According to the ABCD 2 score, large artery stenosis was associated with higher stroke recurrence in both low-risk (adjusted hazard ratio, 1.746 [95% CI, 1.200–2.540]) and moderate-risk group (adjusted hazard ratio, 1.326 [95% CI, 1.042–1.687] ) but not in the high-risk group ( P 〉 0.05). Patients with multiple acute infarctions or single acute infarction had a higher risk of recurrent stroke than those with no infarction in both low- and moderate-risk groups, but not in the high-risk group. Conclusions: Large artery stenosis and infarction number were independent predictors of 1-year stroke recurrence in low-moderate risk but not in high-risk patients with TIA or MIS stratified by ABCD 2 score. This finding emphasizes the importance of early brain and vascular imaging evaluation for risk stratification in patients with TIA or MIS.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.120.032424
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1467823-8
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  • 2
    Online Resource
    Online Resource
    Bleeding Risk of Dual Antiplatelet Therapy after Minor Stroke or Transient Ischemic Attack
    Wiley ; 2022
    In:  Annals of Neurology Vol. 91, No. 3 ( 2022-03), p. 380-388
    Details
    In: Annals of Neurology, Wiley, Vol. 91, No. 3 ( 2022-03), p. 380-388
    Abstract: This study was undertaken to identify the risk of bleeding events and potential risk factors within 90 days in patients who carried CYP2C19 loss‐of‐function alleles and received dual antiplatelet therapy after minor stroke or transient ischemic attack. Methods A total of 6,412 patients were enrolled from the CHANCE‐2 (Clopidogrel with Aspirin in High‐Risk Patients with Acute Non‐disabling Cerebrovascular Events II) trial. The main outcome was any bleeding within 90 days defined by the criteria from GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries). Results A total of 250 (3.9%) bleeding events were reported, which occurred mainly within the 21 days of dual antiplatelet therapy (200 cases, 3.1%). Minor bleeding of the skin bruises, epistaxis, and gum bleeding were most frequent. Multivariate analysis showed that treatment with ticagrelor‐aspirin compared with clopidogrel‐aspirin was associated with increased bleeding (hazard ratio [HR] = 2.21, 95% confidence interval [CI] = 1.68–2.89, p   〈  0.001). Current smoking was associated with a lower risk of bleeding (HR = 0.70, 95% CI = 0.52–0.95, p  = 0.02). Additionally, ticagrelor‐aspirin compared with clopidogrel‐aspirin was associated with higher risk of bleeding in patients aged 〈 65 years (HR = 2.87, 95% CI = 1.95–4.22) and those without diabetes mellitus (HR = 2.65, 95% CI = 1.88–3.73; p for interaction = 0.04 and 0.03, respectively). Interpretation Bleeding events mostly occurred within the 21‐day dual antiplatelet therapy stage and were generally mild. The risk of bleeding was greater in nonsmoking patients, and was associated with treatment with ticagrelor‐aspirin compared with clopidogrel‐aspirin, particularly in patients aged 〈 65 years and nondiabetic patients. ANN NEUROL 2022;91:380–388
    Type of Medium: Online Resource
    ISSN: 0364-5134 , 1531-8249
    URL: Issue
    URL: Article
    DOI: 10.1002/ana.v91.3
    DOI: 10.1002/ana.26287
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2037912-2
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  • 3
    Online Resource
    Online Resource
    Ticagrelor Aspirin vs Clopidogrel Aspirin in CYP2C19 Loss-of-Function Carriers With Minor Stroke or TIA Stratified by Risk Profile
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Neurology Vol. 100, No. 5 ( 2023-01-31), p. e497-e504
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 100, No. 5 ( 2023-01-31), p. e497-e504
    Abstract: Genotype data of the Clopidogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack (CHANCE) trial showed that efficacy of clopidogrel aspirin depended on CYP2C19 genotype and risk profile. A stratification of patients who carried CYP2C19 loss-of-function (LOF) alleles according to the risk of recurrent stroke may be important for selecting optimal antiplatelet therapy. We aimed to compare the efficacy and safety of ticagrelor aspirin with clopidogrel aspirin in CYP2C19 LOF carriers with minor stroke or transient ischemic attack (TIA) stratified by risk profile. Methods Data were obtained from Ticagrelor or Clopidogrel with Aspirin in High-Risk Patients with Acute Nondisabling Cerebrovascular Events II (CHANCE-2) trial. Low-risk and high-risk profiles were defined by Essen Stroke Risk Score (ESRS) ( 〈 3 [low risk] and ≥3 [high risk] , respectively). Results A total of 6,412 CYP2C19 LOF carriers were enrolled; ticagrelor aspirin was associated with a reduced risk of primary outcome (new stroke within 90-day follow-up) in patients at low risk (hazard ratio [HR], 0.65; 95% CI, 0.48–0.82), but not in those at high risk (HR, 0.97; 95% CI, 0.73–1.29), compared with clopidogrel aspirin ( p = 0.02 for interaction). Secondary outcomes generally went in the same direction as the primary outcome. The primary safety outcome of severe or moderate bleeding did not differ based on risk profile ( p = 0.24 for interaction), although the incidence of total bleeding was greater with ticagrelor aspirin than with clopidogrel aspirin among patients at low risk ( p 〈 0.01 for interaction). Analysis in the per-protocol population yielded similar results. Discussion This post hoc analysis of CHANCE-2 trial showed that CYP2C19 LOF carriers with minor stroke or TIA at low risk of recurrent stroke received a greater benefit from ticagrelor aspirin than from clopidogrel aspirin. Classification of Evidence This study provides Class II evidence that CYP2C19 LOF carriers with minor stroke or TIA at low risk, but not at high risk, of recurrent stroke (by the ESRS) received a greater benefit from ticagrelor aspirin than from clopidogrel aspirin. Trial Registration Information URL: www.clinicaltrials.gov. Unique identifier: NCT04078737.
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000201454
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 4
    Online Resource
    Online Resource
    Ticagrelor–Aspirin Versus Clopidogrel–Aspirin Among CYP2C19 Loss-of-Function Carriers With Minor Stroke or Transient Ischemic Attack in Relation to Renal Function: A Post Hoc Analysis of the CHANCE-2 Trial
    American College of Physicians ; 2022
    In:  Annals of Internal Medicine Vol. 175, No. 11 ( 2022-11), p. 1534-1542
    Details
    In: Annals of Internal Medicine, American College of Physicians, Vol. 175, No. 11 ( 2022-11), p. 1534-1542
    Type of Medium: Online Resource
    ISSN: 0003-4819 , 1539-3704
    URL: Article
    DOI: 10.7326/M22-1667
    RVK:
    XA 23600
    Language: English
    Publisher: American College of Physicians
    Publication Date: 2022
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  • 5
    Online Resource
    Online Resource
    Effect of Hypertension on Efficacy and Safety of Ticagrelor-Aspirin Versus Clopidogrel-Aspirin in Minor Stroke or Transient Ischemic Attack
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Stroke Vol. 53, No. 9 ( 2022-09), p. 2799-2808
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. 9 ( 2022-09), p. 2799-2808
    Abstract: Hypertension is a risk factor of poor stroke outcomes and associated with antiplatelet resistance. This study aimed to explore the efficacy and safety of ticagrelor-aspirin versus clopidogrel-aspirin in patients with different hypertension status, using randomized trial data from the CHANCE-2 trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events-II). Methods: A total of 6412 patients with minor stroke or transient ischemic attack who carried CYP2C19 loss-of-function alleles were enrolled and randomized to either ticagrelor-aspirin or clopidogrel-aspirin group. Hypertension status were classified into no, newly diagnosed, and previously diagnosed hypertension according to medical history, blood pressure, and antihypertensive medications during hospitalization. The primary efficacy and safety outcomes were stroke recurrence and moderate to severe bleeding risk within 90-day follow-up. Results: Ticagrelor-aspirin was associated with reduced risk of new stroke in patients without hypertension (32 [4.8%] versus 60 [7.2%] ; hazard ratio, 0.55 [95% CI, 0.35–0.86]), but not in those with a newly diagnosed hypertension (20 [5.3%] versus 36 [9.1%]; hazard ratio 0.59 [95% CI, 0.33–1.07] ), or those with a previously diagnosed hypertension (139 [7.0%] versus 147 [7.4%] ; hazard ratio, 0.93 [95% CI, 0.74–1.18]) compared with clopidogrel-aspirin ( P =0.04 for interaction). The risk of bleeding for ticagrelor-aspirin was not associated with hypertension status (0.1% versus 0.4%; 0.3% versus 0.5%, 0.4% versus 0.3%, P =0.50 for interaction). All the efficacy and safety outcomes between treatments did not differ by blood pressure levels on admission. Conclusions: In the CHANCE-2 trial, patients without hypertension received a significantly greater benefit from ticagrelor- aspirin than those with previous hypertension after minor stroke or transient ischemic attack, and a similar benefit trend was observed in those with newly diagnosed hypertension. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04078737.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.122.038662
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1467823-8
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  • 6
    Online Resource
    Online Resource
    Low serum albumin levels predict poor outcome in patients with acute ischaemic stroke or transient ischaemic attack
    BMJ ; 2021
    In:  Stroke and Vascular Neurology Vol. 6, No. 3 ( 2021-09), p. 458-466
    Details
    In: Stroke and Vascular Neurology, BMJ, Vol. 6, No. 3 ( 2021-09), p. 458-466
    Abstract: To examine the relationship of serum albumin with poor functional outcome and mortality in patients with acute ischaemic stroke (AIS) or transient ischaemic attack (TIA), and perform a meta-analysis to summarise the association. Methods We analysed data from the Third China National Stroke Registry (CNSR-Ⅲ). Patients were divided into four groups based on serum albumin levels at admission. The outcomes included poor functional outcome (modified Rankin Scale (mRS) score of 3 to 6) and mortality at 3 months and 1 year. Multiple logistic regression models and Cox regression models were used to evaluate the association, respectively. We used a fixed-effect model to calculate the risk ratio for poor functional outcome and a random-effect model for mortality in the meta-analysis. Results A total of 13 618 patients were enrolled. During the 3-month follow-up period, compared with 40 to 44.9 g/L group, patients in 〈 35 g/L group had an increased risk of poor functional outcome and mortality (adjusted OR 1.37 (95% CI 1.12 to 1.67); adjusted HR 2.13 (95% CI 1.41 to 3.23)). The relationship in per 10 g/L decreased serum albumin with prognosis was consistently inversed (adjusted OR 1.17 (95% CI 1.01 to 1.35); adjusted HR 1.86 (95% CI 1.30 to 2.64)). Also, low serum albumin levels were independently correlated with clinical outcomes at 1 year. In the meta-analysis, the OR for poor functional outcome pooled 3 studies per 1 g/L decrease was 1.03 (95% CI 1.02 to 1.05), and the HR for mortality pooled 5 studies was 1.07 (95% CI 1.03 to 1.11). Conclusions Low serum albumin levels predict poor functional outcome and mortality in patients with AIS or TIA.
    Type of Medium: Online Resource
    ISSN: 2059-8688 , 2059-8696
    URL: Article
    DOI: 10.1136/svn-2020-000676
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2847692-X
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