PT  - JOURNAL ARTICLE
AU  - Hoshino, Takao
AU  - Uchiyama, Shinichiro
AU  - Wong, Lawrence K.S.
AU  - Kitagawa, Kazuo
AU  - Charles, Hugo
AU  - Labreuche, Julien
AU  - Lavallée, Philippa C.
AU  - Albers, Gregory W.
AU  - Caplan, Louis R.
AU  - Donnan, Geoffrey A.
AU  - Ferro, José M.
AU  - Hennerici, Michael G.
AU  - Molina, Carlos
AU  - Rothwell, Peter M.
AU  - Steg, P. Gabriel
AU  - Touboul, Pierre-Jean
AU  - Vicaut, Éric
AU  - Amarenco, Pierre
AU  - on behalf of the TIA registry.org Investigators
TI  - Five-Year Prognosis After TIA or Minor Ischemic Stroke in Asian and Non-Asian Populations
AID  - 10.1212/WNL.0000000000010995
DP  - 2021 Jan 05
TA  - Neurology
PG  - e54--e66
VI  - 96
IP  - 1
4099  - http://n.neurology.org/content/96/1/e54.short
4100  - http://n.neurology.org/content/96/1/e54.full
SO  - Neurology2021 Jan 05; 96
AB  - Objective To determine long-term vascular outcomes of Asian patients who experienced TIA or minor ischemic stroke and to compare the outcomes of Asian patients with those of non-Asian patients, in the context of modern guideline-based prevention strategies.Methods This is a subanalysis of the TIAregistry.org project, in which 3,847 patients (882 from Asian and 2,965 from non-Asian countries) with a recent TIA or minor ischemic stroke were assessed and treated by specialists at 42 dedicated units from 14 countries and followed for 5 years. The primary outcome was a composite of cardiovascular death, nonfatal stroke, and nonfatal acute coronary syndrome.Results No differences were observed in the 5-year risk of the primary outcome (14.0% vs 11.7%; hazard ratio [HR], 1.10; 95% confidence interval [CI], 0.88–1.37; p = 0.41) and stroke (10.7% vs 8.5%; HR, 1.17; 95% CI, 0.90–1.51; p = 0.24) between Asian and non-Asian patients. Asian participants were at higher risk of intracranial hemorrhage (1.8% vs 0.8%; HR, 2.23; 95% CI, 1.09–4.57; p = 0.029). Multivariable analysis showed that the presence of multiple acute infarctions on initial brain imaging was an independent predictor of primary outcome and modified Rankin Scale score of >1 in both Asian (HR, 1.91; 95% CI, 1.11–3.29; p = 0.020) and non-Asian (HR, 1.39; 95% CI, 1.02–1.90; p = 0.037) patients.Conclusion The long-term risk of vascular events in Asian patients was as low as that in non-Asian patients, while Asian participants had a 2.2-fold higher intracranial hemorrhage risk. Multiple acute infarctions were independently associated with future disability in both groups.Classification of Evidence This study provides Class I evidence that among people who experienced TIA or minor stroke, Asian patients have a similar 5-year risk of cardiovascular death, stroke, and acute coronary syndrome as non-Asian patients.CHANCE=Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events; CI=confidence interval; HR=hazard ratio; ICH=intracranial hemorrhage; mRS=modified Rankin Scale; TOAST=Trial of Org 10172 in Acute Stroke Treatment