RT Journal Article
SR Electronic
T1 High-sensitive C-reactive protein and dual antiplatelet in intracranial arterial stenosis
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 10.1212/WNL.0000000000004928
DO 10.1212/WNL.0000000000004928
A1 Li, Jiejie
A1 Wang, Anxin
A1 Zhao, Xingquan
A1 Liu, Liping
A1 Meng, Xia
A1 Lin, Jinxi
A1 Jing, Jing
A1 Zou, Xinying
A1 Wang, Yilong
A1 Wang, Yongjun
A1 ,
YR 2018
UL http://n.neurology.org/content/early/2018/01/12/WNL.0000000000004928.abstract
AB Objective To determine the relationship of high-sensitive C-reactive protein (hsCRP) and the efficacy and safety of dual antiplatelet therapy in patients with and without intracranial arterial stenosis (ICAS) in the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial.Methods A subgroup of 807 patients with both magnetic resonance angiography images and hsCRP measurement was analyzed. Cox proportional hazards models were used to assess the interaction of hsCRP levels with the effects of dual and single antiplatelet therapy.Results A total of 358 (44.4%) patients had ICAS and 449 (55.6%) did not. The proportion of patients with elevated hsCRP levels was higher in the ICAS group than in the non-ICAS group (40.2% vs 30.1%, p = 0.003). There was significant interaction between hsCRP and the 2 antiplatelet therapy groups in their effects on recurrent stroke after adjustment for confounding factors in the patients with ICAS (p = 0.012), but not in those without (p = 0.256). Compared with aspirin alone, clopidogrel plus aspirin significantly reduced the risk of recurrent stroke only in the patients with ICAS and nonelevated hsCRP levels (adjusted hazard ratio 0.27; 95% confidence interval 0.11 to 0.69; p = 0.006). Similar results were observed for composite vascular events. No significant difference in bleeding was found.Conclusions Presence of both ICAS and nonelevated hsCRP levels may predict better response to dual antiplatelet therapy in reducing new stroke and composite vascular events in minor stroke or high-risk TIA patients. Further large-scale randomized and controlled clinical trials are needed to confirm this finding.