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De Matteis E, Ornello R, De Santis F, Foschi M, Romoli M, Tassinari T, Saia V, Cenciarelli S, Bedetti C, Padiglioni C, Censori B, Puglisi V, Vinciguerra L, Guarino M, Barone V, Zedde M, Grisendi I, Diomedi M, Bagnato MR, Petruzzellis M, Mezzapesa DM, Di Viesti P, Inchingolo V, Cappellari M, Zenorini M, Candelaresi P, Andreone V, Rinaldi G, Bavaro A, Cavallini A, Moraru S, Querzani P, Terruso V, Mannino M, Pezzini A, Frisullo G, Muscia F, Paciaroni M, Mosconi MG, Zini A, Leone R, Palmieri C, Cupini LM, Marcon M, Tassi R, Sanzaro E, Paci C, Viticchi G, Orsucci D, Falcou A, Diamanti S, Tarletti R, Nencini P, Rota E, Sepe FN, Ferrandi D, Caputi L, Volpi G, Spada SL, Beccia M, Rinaldi C, Mastrangelo V, Di Blasio F, Invernizzi P, Pelliccioni G, De Angelis MV, Bonanni L, Ruzza G, Caggia EA, Russo M, Tonon A, Acciarri MC, Anticoli S, Roberti C, Manobianca G, Scaglione G, Pistoia F, Fortini A, De Boni A, Sanna A, Chiti A, Barbarini L, Caggiula M, Masato M, Del Sette M, Passarelli F, Roberta Bongioanni M, Toni D, Ricci S, Sacco S. Beyond RCTs: Short-term dual antiplatelet therapy in secondary prevention of ischemic stroke and transient ischemic attack. Eur Stroke J 2024:23969873241255250. [PMID: 38869034 DOI: 10.1177/23969873241255250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND AND PURPOSE Randomized controlled trials (RCTs) proved the efficacy of short-term dual antiplatelet therapy (DAPT) in secondary prevention of minor ischemic stroke or high-risk transient ischemic attack (TIA). We aimed at evaluating effectiveness and safety of short-term DAPT in real-world, where treatment use is broader than in RCTs. METHODS READAPT (REAl-life study on short-term Dual Antiplatelet treatment in Patients with ischemic stroke or Transient ischemic attack) (NCT05476081) was an observational multicenter real-world study with a 90-day follow-up. We included patients aged 18+ receiving short-term DAPT soon after ischemic stroke or TIA. No stringent NIHSS and ABCD2 score cut-offs were applied but adherence to guidelines was recommended. Primary effectiveness outcome was stroke (ischemic or hemorrhagic) or death due to vascular causes, primary safety outcome was moderate-to-severe bleeding. Secondary outcomes were the type of ischemic and hemorrhagic events, disability, cause of death, and compliance to treatment. RESULTS We included 1920 patients; 69.9% started DAPT after an ischemic stroke; only 8.9% strictly followed entry criteria or procedures of RCTs. Primary effectiveness outcome occurred in 3.9% and primary safety outcome in 0.6% of cases. In total, 3.3% cerebrovascular ischemic recurrences occurred, 0.2% intracerebral hemorrhages, and 2.7% bleedings; 0.2% of patients died due to vascular causes. Patients with NIHSS score ⩽5 and those without acute lesions at neuroimaging had significantly higher primary effectiveness outcomes than their counterparts. Additionally, DAPT start >24 h after symptom onset was associated with a lower likelihood of bleeding. CONCLUSIONS In real-world, most of the patients who receive DAPT after an ischemic stroke or a TIA do not follow RCTs entry criteria and procedures. Nevertheless, short-term DAPT remains effective and safe in this population. No safety concerns are raised in patients with low-risk TIA, more severe stroke, and delayed treatment start.
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Affiliation(s)
- Eleonora De Matteis
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Department of Brain Sciences, Imperial College London, London, UK
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Federico De Santis
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Matteo Foschi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michele Romoli
- Department of Neuroscience, Maurizio Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Tiziana Tassinari
- Department of Neurology, Santa Corona Hospital, Pietra Ligure, Italy
| | - Valentina Saia
- Department of Neurology, Santa Corona Hospital, Pietra Ligure, Italy
| | - Silvia Cenciarelli
- Department of Neurology, Città di Castello Hospital, Città di Castello, Italy
| | - Chiara Bedetti
- Department of Neurology, Città di Castello Hospital, Città di Castello, Italy
| | - Chiara Padiglioni
- Department of Neurology, Città di Castello Hospital, Città di Castello, Italy
| | - Bruno Censori
- Department of Neurology, ASST Cremona Hospital, Cremona, Italy
| | | | | | - Maria Guarino
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Valentina Barone
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Grisendi
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marina Diomedi
- Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | | | - Marco Petruzzellis
- Department of Neurology and Stroke Unit, "F. Puca" AOU Consorziale Policlinico, Bari, Italy
| | | | - Pietro Di Viesti
- Department of Neurology, Fondazione IRCCS Casa sollievo della sofferenza, San Giovanni Rotondo, Italy
| | - Vincenzo Inchingolo
- Department of Neurology, Fondazione IRCCS Casa sollievo della sofferenza, San Giovanni Rotondo, Italy
| | - Manuel Cappellari
- Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata Verona, Verona
| | - Mara Zenorini
- Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata Verona, Verona
| | - Paolo Candelaresi
- Department of Neurology and Stroke Unit, AORN Antonio Cardarelli, Naples, Italy
| | - Vincenzo Andreone
- Department of Neurology and Stroke Unit, AORN Antonio Cardarelli, Naples, Italy
| | | | | | - Anna Cavallini
- UO Neurologia d'Urgenza e Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Stefan Moraru
- UO Neurologia d'Urgenza e Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Pietro Querzani
- Department of Neuroscience, S.Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | - Valeria Terruso
- Department of Neurology, AOOR Villa Sofia-Cervello, Palermo, Italy
| | - Marina Mannino
- Department of Neurology, AOOR Villa Sofia-Cervello, Palermo, Italy
| | - Alessandro Pezzini
- Department of Medicine and Surgery, University of Parma, Stroke Care Program, Department of Emergency, Parma University Hospital, Parma, Italy
| | - Giovanni Frisullo
- Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | | | - Maurizio Paciaroni
- Department of Internal and Cardiovascular Medicine - Stroke Unit, University Hospital Santa Maria della Misericordia, Perugia, Italy
| | - Maria Giulia Mosconi
- Department of Internal and Cardiovascular Medicine - Stroke Unit, University Hospital Santa Maria della Misericordia, Perugia, Italy
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - Ruggiero Leone
- Department of Neurology and Stroke Unit, "M. R. Dimiccoli" General Hospital, Barletta, ASL BT, Italy
| | - Carmela Palmieri
- Medical Department, E. Agnelli Hospital - Local Health Company (ASL) TO3, Pinerolo, Italy
| | | | - Michela Marcon
- Department of Neurology, Cazzavillan Hospital Arzignano, Vicenza, Italy
| | - Rossana Tassi
- Stroke Unit, Urgency and Emergency Department, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Enzo Sanzaro
- Department of Neurology, Umberto I Hospital, Siracusa, Italy
| | - Cristina Paci
- UOC Neurologia, Ospedale "Madonna del Soccorso", San Benedetto del Tronto, Italy
| | - Giovanna Viticchi
- Experimental and Clinical Medicine Department, Marche Polytechnic University, Ancona
| | - Daniele Orsucci
- Unit of Neurology-San Luca Hospital, Lucca and Castelnuovo Garfagnana, Italy
| | - Anne Falcou
- Stroke Unit, Emergency Department, Policlinico Umberto I Hospital, Rome, Italy
| | - Susanna Diamanti
- Department of Neurology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Roberto Tarletti
- SCDU Neurologia - Stroke Unit, Azienda Ospedaliero-Universitaria "Maggiore della Carità", Novara, Italy
| | | | - Eugenia Rota
- Department of Neurology, San Giacomo Hospital, Novi Ligure, Italy
| | | | - Delfina Ferrandi
- Stroke Unit-Department of Neurology, SS. Biagio e Arrigo Hospital, Alessandria, Italy
| | - Luigi Caputi
- Department of Cardiocerebrovascular diseases, Neurology-Stroke Unit-ASST Ospedale Maggiore di Crema, Crema, Italy
| | - Gino Volpi
- Department of Neurology, San Jacopo Hospital, Pistoia, Italy
| | | | - Mario Beccia
- Department of Neurology, Sant'Andrea Hospital, Rome, Italy
| | - Claudia Rinaldi
- Neurology Unit, "Infermi" Hospital, AUSL Romagna, Rimini, Italy
| | | | | | - Paolo Invernizzi
- Departiment of Neurology, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | | | - Maria Vittoria De Angelis
- Stroke Unit, "S.Spirito" Hospital, Pescara, Italy
- Department of Neurology and Stroke Unit, SS Annunziata Hospital, Chieti, Italy
| | - Laura Bonanni
- Dipartimento di Medicina e Scienze dell'Invecchiamento, Università G. d'Annunzio di Chieti-Pescara e Clinica Neurologica e Stroke Unit Ospedale Clinicizzato SS. Annunziata di Chieti, Chieti, Italy
| | | | | | - Monia Russo
- Department of Neurology, St Misericordia Hospital, Rovigo, Italy
| | - Agnese Tonon
- Department of Neurology, Ospedale Civile Ss. Giovanni e Paolo, Venice, Italy
| | | | | | - Cinzia Roberti
- Department of Neurology, San Filippo Neri Hospital, Rome, Italy
| | - Giovanni Manobianca
- Department of Neurology, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Italy
| | - Gaspare Scaglione
- Department of Neurology, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Italy
| | - Francesca Pistoia
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alberto Fortini
- Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy
| | | | | | - Alberto Chiti
- Unit of Neurology, Apuane Hospital, Massa Carrara, Italy
| | | | | | - Maela Masato
- Department of Neurology, Mirano Hospital, Mirano, Italy
| | - Massimo Del Sette
- Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Danilo Toni
- Department of Human neurosciences, University of Rome La Sapienza, Rome, Italy
| | - Stefano Ricci
- Department of Neurology, Città di Castello Hospital, Città di Castello, Italy
- Coordinatore Comitato Scientifico ISA-AII
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Gao Y, Jiang L, Pan Y, Chen W, Jing J, Wang C, Johnston SC, Amarenco P, Bath PM, Yang Y, Wang T, Han S, Meng X, Lin J, Zhao X, Liu L, Zhao J, Li Y, Zang Y, Zhang S, Yang H, Yang J, Wang Y, Li D, Wang Y, Liu D, Kang G, Wang Y, Wang Y. Immediate- or Delayed-Intensive Statin in Acute Cerebral Ischemia: The INSPIRES Randomized Clinical Trial. JAMA Neurol 2024:2819378. [PMID: 38805216 PMCID: PMC11134282 DOI: 10.1001/jamaneurol.2024.1433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 03/29/2024] [Indexed: 05/29/2024]
Abstract
Importance Comparisons are limited for immediate-intensive and delayed-intensive statin for secondary stroke prevention and neuroprotection in patients with acute mild ischemic stroke or transient ischemic attack (TIA) from atherosclerosis. Objective To estimate whether immediate-intensive statin therapy is safe and can lower the risk of recurrent stroke compared with delayed-intensive statin in patients with acute mild ischemic stroke or high-risk TIA from atherosclerosis. Design, Setting, and Participants The Intensive Statin and Antiplatelet Therapy for High-Risk Intracranial or Extracranial Atherosclerosis (INSPIRES) trial, a double-blind, placebo-controlled, 2 × 2 factorial, randomized clinical trial enrolled patients from September 2018 to October 2022. The trial was conducted at 222 hospitals in China. Patients aged 35 to 80 years with mild ischemic stroke or high-risk TIA of presumed atherosclerosis within 72 hours of symptom onset were assessed. Interventions Patients were randomly assigned to receive immediate-intensive atorvastatin (80 mg daily on days 1-21; 40 mg daily on days 22-90) or 3-day delayed treatment (placebo for days 1-3, followed by placebo and atorvastatin, 40 mg daily on days 4-21, and then atorvastatin, 40 mg daily on days 22-90). Main Outcomes and Measures The primary efficacy outcome was new stroke within 90 days, and a secondary efficacy outcome was poor functional outcome. Moderate to severe bleeding was the primary safety outcome. Results A total of 11 431 patients were assessed for eligibility, and 6100 patients (median [IQR] age, 65 [57-71] years; 3915 men [64.2%]) were enrolled, with 3050 assigned to each treatment group. Within 90 days, new stroke occurred in 245 patients (8.1%) in the immediate-intensive statin group and 256 patients (8.4%) in the delayed group (hazard ratio, 0.95; 95% CI, 0.80-1.13). Poor functional outcome occurred in 299 patients (9.8%) and 348 patients (11.4%) in the immediate-intensive and delayed-intensive statin groups, respectively (odds ratio, 0.83; 95% CI, 0.71-0.98). Moderate to severe bleeding occurred in 23 of 3050 patients (0.8%) and 17 of 3050 patients (0.6%), in the immediate-intensive and delayed-intensive statin groups, respectively. Conclusions and Relevance Immediate-intensive statin initiated within 72 hours did not reduce the risk of stroke within 90 days and may be associated with improved functional outcomes without significant difference in moderate to severe bleeding, compared with 3-day delayed-intensive statin in Chinese patients with acute mild ischemic stroke or TIA from atherosclerosis. Trial Registration ClinicalTrials.gov Identifier: NCT03635749.
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Affiliation(s)
- Ying Gao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lingling Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Weiqi Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Chunjuan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | | | - Pierre Amarenco
- Department of Neurology and Stroke Center, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, INSERM LVTS-U1148, University of Paris, Paris, France
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Philip M. Bath
- Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Yingying Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tingting Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shangrong Han
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jinxi Lin
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jinguo Zhao
- Department of Neurology, Weihai Wendeng District People’s Hospital, Weihai, China
| | - Ying Li
- Department of Neurology, Sui Chinese Medical Hospital, Shangqiu, China
| | - Yingzhuo Zang
- Department of Neurology, Qinghe People’s Hospital, Xingtai, China
| | - Shuo Zhang
- Department of Neurology, Biyang People’s Hospital, Zhumadian, China
| | - Hongqin Yang
- Department of Neurology, Jiyuan Chinese Medical Hospital, Jiyuan, China
| | - Jianbo Yang
- Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yuanwei Wang
- Department of Neurology, The Affiliated Shuyang Hospital of Xuzhou Medical University, Shuyang Hospital, Suqian, China
| | - Dali Li
- Department of Neurology, Mengzhou People’s Hospital, Jiaozuo, China
| | - Yanxia Wang
- Department of Neurology, Hejian People’s Hospital, Cangzhou, China
| | - Dongqi Liu
- Department of Neurology, Hejian People’s Hospital, Cangzhou, China
| | - Guangming Kang
- Department of Neurology, Xiuwu People’s Hospital, Jiaozuo, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
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Groff H, Yousfani S, Pantoja-Ruiz C, Douiri A, Bhalla A, Wolfe C, Marshall IJ. A systematic review of the incidence and outcomes of ICD-11 defined stroke. J Stroke Cerebrovasc Dis 2024; 33:107784. [PMID: 38795795 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND The World Health Organisation has expanded the definition of stroke to include people with symptoms less than 24 h if they have evidence of stroke on neuroimaging. The impact is that people previously diagnosed as having a transient ischaemic attack (TIA) would now be considered to have had a stroke. This change will impact incidence and outcomes of stroke and increase eligibility for secondary prevention. We aimed to evaluate the new ICD-11 criteria retrospectively to previous TIA studies to understand the change in incidence and outcomes of this type of stroke. METHODS We conducted a systematic review of observational studies of the incidence and outcomes of clinically defined TIA. We searched PubMed, EMBASE, and Google Scholar from inception to 23rd May 2023. Study quality was assessed using a risk of bias tool for prevalence studies. FINDINGS Our review included 25 studies. The rate of scan positivity for stroke among those with clinically defined TIA was 24 %, (95 % CI, 16-33 %) but with high heterogeneity (I2 = 100 %, p <0.001). Sensitivity analyses provided evidence that heterogeneity could be explained by methodology and recruitment method. The scan positive rate when examining only studies at low risk of bias was substantially lower, at 13 % (95 % CI, 11-15 %, I2 = 0, p = 0.77). We estimate from population-based incidence studies that ICD-11 would result in an increase stroke incidence between 4.8 and 10.5 per 100,000 persons/year. Of those with DWI-MRI evidence of stroke, 6 % (95 % CI, 3-11 %) developed a recurrent stroke in the subsequent 90 days, but with substantial heterogeneity (I2 = 67 %, p = 0.02). CONCLUSION The impact of the ICD-11 change in stroke definition on incidence and outcomes may have been overestimated by individual studies. Community-based stroke services with access to DWI MRI are likely to accurately diagnose greater numbers of people with mild ICD-11 stroke, increasing access to effective prevention.
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Affiliation(s)
- Holli Groff
- School of Life Course and Population Science, King's College London, London, UK
| | - Sariha Yousfani
- School of Life Course and Population Science, King's College London, London, UK
| | - Camila Pantoja-Ruiz
- School of Life Course and Population Science, King's College London, London, UK
| | - Abdel Douiri
- School of Life Course and Population Science, King's College London, London, UK; NIHR ARC South London, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Ajay Bhalla
- School of Life Course and Population Science, King's College London, London, UK; NIHR ARC South London, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Department of Ageing Health and Stroke, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - Charles Wolfe
- School of Life Course and Population Science, King's College London, London, UK; NIHR ARC South London, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Iain J Marshall
- School of Life Course and Population Science, King's College London, London, UK; NIHR ARC South London, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
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Schneckenburger R, Boulanger M, Nehme A, Watrin M, Le Du G, Guettier S, Guittet L, Touzé E. Epidemiology of transient ischemic attack in the normandy stroke population-based study. Eur Stroke J 2024:23969873241251722. [PMID: 38711259 DOI: 10.1177/23969873241251722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION Transient ischemic attack (TIA) is a frequent neurological emergency which management and definition have changed radically over the last 15 years. However, recent epidemiological studies of TIA are scarce. We report here on the impact of the shift from a time-based to a tissue-based definition of TIA on its incidence and risk of recurrence in a new population-based cohort with a high rate of patients investigated by MRI. MATERIALS AND METHODS We prospectively included all TIAs that occurred between May 2017 and May 2021 from the Normandy Stroke Study, a population-based registry using multiple overlapping sources for exhaustive case identification in Caen la Mer area. TIAs were classified as either time-based (symptoms <24 h) or tissue-based (<24 h and no lesion on brain imaging). Attack and incidence rates were calculated, as was the 90-day ischemic stroke rate. RESULTS Five hundred and sixty-seven TIAs (549 single patients) were included, with 80.6% having a brain MRI. Four hundred and ten (72.3%) met the definition of tissue-based TIA. The age standardized attack (to the 2013 European population) rate was 39.5 (95% CI 35.7-43.5) and the age-standardized incidence rate (first ever cerebrovascular event) was 29.7 (95% CI 27.3-34.2). The overall recurrent stroke rate at 90 days was 2.7%, with no difference between patients with or without ischemic lesions on MRI. CONCLUSION We found that the use of the tissue-based definition of TIA resulted in a 27.5% reduction in incidence as compared to the time-based definition, but had no impact on the 90-day stroke rate. The burden of TIA remains high, and is likely to increase as the population ages.
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Affiliation(s)
- Romain Schneckenburger
- Université Caen Normandie, Caen, France
- Department of Neurology, CHU de Caen Normandie, Caen, France
- INSERM UMR-S U1237 PhIND/BB@C, Caen, France
| | - Marion Boulanger
- Université Caen Normandie, Caen, France
- Department of Neurology, CHU de Caen Normandie, Caen, France
- INSERM UMR-S U1237 PhIND/BB@C, Caen, France
| | - Ahmad Nehme
- Université Caen Normandie, Caen, France
- Department of Neurology, CHU de Caen Normandie, Caen, France
- INSERM UMR-S U1237 PhIND/BB@C, Caen, France
| | - Marguerite Watrin
- INSERM UMR-S U1237 PhIND/BB@C, Caen, France
- Department of Clinical Research, CHU de Caen Normandie, Caen, France
| | - Gwendoline Le Du
- INSERM UMR-S U1237 PhIND/BB@C, Caen, France
- Department of Clinical Research, CHU de Caen Normandie, Caen, France
| | - Sophie Guettier
- Department of Neurology, CHU de Caen Normandie, Caen, France
| | - Lydia Guittet
- Université Caen Normandie, Caen, France
- Department of Clinical Research, CHU de Caen Normandie, Caen, France
| | - Emmanuel Touzé
- Université Caen Normandie, Caen, France
- Department of Neurology, CHU de Caen Normandie, Caen, France
- INSERM UMR-S U1237 PhIND/BB@C, Caen, France
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Meng X, Wang A, Tian X, Johnston C, Li H, Bath PM, Xu Q, Zhang Y, Xie X, Jing J, Lin J, Wang Y, Zhao X, Li Z, Jiang Y, Liu L, Wang Y. One-Year Outcomes of Early Therapy With Ticagrelor vs Clopidogrel in CYP2C19 Loss-of-Function Carriers With Stroke or TIA Trial. Neurology 2024; 102:e207809. [PMID: 38181311 DOI: 10.1212/wnl.0000000000207809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 11/07/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The Ticagrelor or Clopidogrel with Aspirin in High-Risk Patients with Acute Nondisabling Cerebrovascular Events II (CHANCE-2) trial showed that among Chinese patients with minor ischemic stroke or transient ischemic attack (TIA) who were carriers of CYP2C19 loss-of-function alleles, dual-antiplatelet therapy with ticagrelor-aspirin reduced the 90-day risk of stroke without increased severe or moderate bleeding compared with clopidogrel-aspirin. However, whether dual-antiplatelet therapy with ticagrelor was superior to clopidogrel beyond the 90 days of follow-up remained unclear. In this study, we reported 1-year follow-up outcomes of the CHANCE-2 trial. METHODS The CHANCE-2 trial is a randomized, double-blind, placebo-controlled trial at 202 centers in China. Patients with a minor stroke or TIA who carried CYP2C19 loss-of-function alleles were randomized within 24 hours after symptom onset, in a 1:1 ratio, to receive ticagrelor and placebo clopidogrel or to receive clopidogrel and placebo ticagrelor for 90 days; both groups received aspirin for the first 21 days. After day 90, treatment was as per the choice of the clinician and the patient. RESULTS Among 6,412 patients, the proportion of patients on ticagrelor plus aspirin, clopidogrel plus aspirin, ticagrelor alone, clopidogrel alone, aspirin alone, other antiplatelet, and no antiplatelet beyond month 3 to 1 year was 0.09%, 1.56%, 0.13%, 2.66%, 73.65%, 0.78%, and 21.13% in the ticagrelor-aspirin group and 0.03%, 1.63%, 0.19%, 2.60%, 72.83%, 0.66%, and 22.06% in the clopidogrel-aspirin group, respectively. The primary outcome of new stroke occurred in 252 patients (7.91%) in the ticagrelor-aspirin group and 310 patients (9.73%) in the clopidogrel-aspirin group by 1 year of follow-up (hazard ratio 0.80; 95% CI 0.68-0.95; p = 0.007); new stroke beyond 3 months to 1 year occurred in 61 patients (2.07%) and 67 patients (2.32%) (p = 0.48), respectively. Primary safety outcome of severe or moderate bleeding occurred in 17 patients (0.53%) in the ticagrelor-aspirin group and 20 patients (0.63%) in the clopidogrel-aspirin group (p = 0.61). DISCUSSION For CYP2C19 loss-of-function allele carriers, early dual-antiplatelet therapy with ticagrelor is superior to clopidogrel at 1 year in reducing recurrent stroke. TRIAL REGISTRATION INFORMATION URL: clinicaltrials.gov. Unique identifier: NCT04078737. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for patients with minor stroke or TIA with TIACYP2C19 loss-of-function, ticagrelor plus aspirin for 21 days is superior to clopidogrel plus aspirin in reducing the 1-year risk of recurrent stroke.
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Affiliation(s)
- Xia Meng
- From the Department of Neurology (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.) and Advanced Innovation Center for Human Brain Protection (Yo.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.), Beijing; Department of Epidemiology and Health Statistics (X.T., Y.Z.), School of Public Health, Capital Medical University, Beijing; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.,Y.Z.), China; Department of Neurology (S.C.J.), University of California, San Francisco; and Stroke Trials Unit (P.M.B.), Mental Health & Clinical Neuroscience, University of Nottingham, UK
| | - Anxin Wang
- From the Department of Neurology (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.) and Advanced Innovation Center for Human Brain Protection (Yo.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.), Beijing; Department of Epidemiology and Health Statistics (X.T., Y.Z.), School of Public Health, Capital Medical University, Beijing; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.,Y.Z.), China; Department of Neurology (S.C.J.), University of California, San Francisco; and Stroke Trials Unit (P.M.B.), Mental Health & Clinical Neuroscience, University of Nottingham, UK
| | - Xue Tian
- From the Department of Neurology (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.) and Advanced Innovation Center for Human Brain Protection (Yo.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.), Beijing; Department of Epidemiology and Health Statistics (X.T., Y.Z.), School of Public Health, Capital Medical University, Beijing; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.,Y.Z.), China; Department of Neurology (S.C.J.), University of California, San Francisco; and Stroke Trials Unit (P.M.B.), Mental Health & Clinical Neuroscience, University of Nottingham, UK
| | - Claiborne Johnston
- From the Department of Neurology (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.) and Advanced Innovation Center for Human Brain Protection (Yo.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.), Beijing; Department of Epidemiology and Health Statistics (X.T., Y.Z.), School of Public Health, Capital Medical University, Beijing; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.,Y.Z.), China; Department of Neurology (S.C.J.), University of California, San Francisco; and Stroke Trials Unit (P.M.B.), Mental Health & Clinical Neuroscience, University of Nottingham, UK
| | - Hao Li
- From the Department of Neurology (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.) and Advanced Innovation Center for Human Brain Protection (Yo.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.), Beijing; Department of Epidemiology and Health Statistics (X.T., Y.Z.), School of Public Health, Capital Medical University, Beijing; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.,Y.Z.), China; Department of Neurology (S.C.J.), University of California, San Francisco; and Stroke Trials Unit (P.M.B.), Mental Health & Clinical Neuroscience, University of Nottingham, UK
| | - Philip M Bath
- From the Department of Neurology (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.) and Advanced Innovation Center for Human Brain Protection (Yo.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.), Beijing; Department of Epidemiology and Health Statistics (X.T., Y.Z.), School of Public Health, Capital Medical University, Beijing; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.,Y.Z.), China; Department of Neurology (S.C.J.), University of California, San Francisco; and Stroke Trials Unit (P.M.B.), Mental Health & Clinical Neuroscience, University of Nottingham, UK
| | - Qin Xu
- From the Department of Neurology (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.) and Advanced Innovation Center for Human Brain Protection (Yo.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.), Beijing; Department of Epidemiology and Health Statistics (X.T., Y.Z.), School of Public Health, Capital Medical University, Beijing; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.,Y.Z.), China; Department of Neurology (S.C.J.), University of California, San Francisco; and Stroke Trials Unit (P.M.B.), Mental Health & Clinical Neuroscience, University of Nottingham, UK
| | - Yijun Zhang
- From the Department of Neurology (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.) and Advanced Innovation Center for Human Brain Protection (Yo.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.), Beijing; Department of Epidemiology and Health Statistics (X.T., Y.Z.), School of Public Health, Capital Medical University, Beijing; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.,Y.Z.), China; Department of Neurology (S.C.J.), University of California, San Francisco; and Stroke Trials Unit (P.M.B.), Mental Health & Clinical Neuroscience, University of Nottingham, UK
| | - Xuewei Xie
- From the Department of Neurology (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.) and Advanced Innovation Center for Human Brain Protection (Yo.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.), Beijing; Department of Epidemiology and Health Statistics (X.T., Y.Z.), School of Public Health, Capital Medical University, Beijing; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.,Y.Z.), China; Department of Neurology (S.C.J.), University of California, San Francisco; and Stroke Trials Unit (P.M.B.), Mental Health & Clinical Neuroscience, University of Nottingham, UK
| | - Jing Jing
- From the Department of Neurology (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.) and Advanced Innovation Center for Human Brain Protection (Yo.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.), Beijing; Department of Epidemiology and Health Statistics (X.T., Y.Z.), School of Public Health, Capital Medical University, Beijing; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.,Y.Z.), China; Department of Neurology (S.C.J.), University of California, San Francisco; and Stroke Trials Unit (P.M.B.), Mental Health & Clinical Neuroscience, University of Nottingham, UK
| | - Jinxi Lin
- From the Department of Neurology (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.) and Advanced Innovation Center for Human Brain Protection (Yo.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.), Beijing; Department of Epidemiology and Health Statistics (X.T., Y.Z.), School of Public Health, Capital Medical University, Beijing; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.,Y.Z.), China; Department of Neurology (S.C.J.), University of California, San Francisco; and Stroke Trials Unit (P.M.B.), Mental Health & Clinical Neuroscience, University of Nottingham, UK
| | - Yilong Wang
- From the Department of Neurology (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.) and Advanced Innovation Center for Human Brain Protection (Yo.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.), Beijing; Department of Epidemiology and Health Statistics (X.T., Y.Z.), School of Public Health, Capital Medical University, Beijing; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.,Y.Z.), China; Department of Neurology (S.C.J.), University of California, San Francisco; and Stroke Trials Unit (P.M.B.), Mental Health & Clinical Neuroscience, University of Nottingham, UK
| | - Xingquan Zhao
- From the Department of Neurology (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.) and Advanced Innovation Center for Human Brain Protection (Yo.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.), Beijing; Department of Epidemiology and Health Statistics (X.T., Y.Z.), School of Public Health, Capital Medical University, Beijing; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.,Y.Z.), China; Department of Neurology (S.C.J.), University of California, San Francisco; and Stroke Trials Unit (P.M.B.), Mental Health & Clinical Neuroscience, University of Nottingham, UK
| | - Zixiao Li
- From the Department of Neurology (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.) and Advanced Innovation Center for Human Brain Protection (Yo.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.), Beijing; Department of Epidemiology and Health Statistics (X.T., Y.Z.), School of Public Health, Capital Medical University, Beijing; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.,Y.Z.), China; Department of Neurology (S.C.J.), University of California, San Francisco; and Stroke Trials Unit (P.M.B.), Mental Health & Clinical Neuroscience, University of Nottingham, UK
| | - Yong Jiang
- From the Department of Neurology (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.) and Advanced Innovation Center for Human Brain Protection (Yo.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.), Beijing; Department of Epidemiology and Health Statistics (X.T., Y.Z.), School of Public Health, Capital Medical University, Beijing; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.,Y.Z.), China; Department of Neurology (S.C.J.), University of California, San Francisco; and Stroke Trials Unit (P.M.B.), Mental Health & Clinical Neuroscience, University of Nottingham, UK
| | - Liping Liu
- From the Department of Neurology (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.) and Advanced Innovation Center for Human Brain Protection (Yo.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.), Beijing; Department of Epidemiology and Health Statistics (X.T., Y.Z.), School of Public Health, Capital Medical University, Beijing; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.,Y.Z.), China; Department of Neurology (S.C.J.), University of California, San Francisco; and Stroke Trials Unit (P.M.B.), Mental Health & Clinical Neuroscience, University of Nottingham, UK
| | - Yongjun Wang
- From the Department of Neurology (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.) and Advanced Innovation Center for Human Brain Protection (Yo.W.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (X.M., A.W., X.T., H.L., Y.Z., X.X., J.J., J.L., Yi.W., X.Z., Z.L., L.L., Y.J., Yo.W.), Beijing; Department of Epidemiology and Health Statistics (X.T., Y.Z.), School of Public Health, Capital Medical University, Beijing; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.,Y.Z.), China; Department of Neurology (S.C.J.), University of California, San Francisco; and Stroke Trials Unit (P.M.B.), Mental Health & Clinical Neuroscience, University of Nottingham, UK
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Wang A, Tian X, Xie X, Li H, Bath PM, Jing J, Lin J, Wang Y, Zhao X, Li Z, Liu L, Wang Y, Meng X. Differential effect of ticagrelor versus clopidogrel by homocysteine levels on risk of recurrent stroke: a post hoc analysis of the CHANCE-2 trial. CMAJ 2024; 196:E149-E156. [PMID: 38346785 PMCID: PMC10861269 DOI: 10.1503/cmaj.231262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Elevated homocysteine levels are associated with increased blood coagulation and platelet activity and may modulate the response to antiplatelet therapies. We aimed to investigate the effects of homocysteine levels on the efficacy and safety of ticagrelor-acetylsalicylic acid (ASA) versus clopidogrel-ASA among patients with minor stroke or transient ischemic attack who carried CYP2C19 loss-of-function alleles. METHODS We conducted a post hoc analysis of the CHANCE-2 (The Clopidogrel in High-risk Patients with Acute Nondisabling Cerebrovascular Events-II) trial. Participants were randomly assigned to treatment with ticagrelor-ASA or clopidogrel-ASA. We categorized participants into groups with elevated and non-elevated homocysteine levels, based on the median level. The primary efficacy outcome was recurrent stroke within 90-day follow-up. The primary safety outcome was severe or moderate bleeding within 90 days. RESULTS A total of 2740 participants were randomly assigned to receive ticagrelor-ASA and 2700 to receive clopidogrel-ASA. Use of ticagrelor-ASA was associated with a reduced risk of recurrent stroke among participants with elevated homocysteine levels (74 [5.3%] v. 119 [8.5%]; hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.45-0.81), but not among those with non-elevated levels (86 [6.4%] v. 87 [6.7%]; HR 0.97, 95% CI 0.71-1.32; p = 0.04 for interaction). When analyzed as a continuous variable, the benefits of ticagrelor-ASA with regard to recurrent stroke increased as homocysteine levels increased (p = 0.04 for interaction). No significant interaction between homocysteine levels and treatment with regard to severe or moderate bleeding was observed (p = 0.7 for interaction). We found a significant interaction between homocysteine levels and therapy with regard to recurrent stroke in females (p = 0.04 for interaction) but not males. INTERPRETATION In comparison with clopidogrel-ASA, ticagrelor-ASA conferred more benefit to patients with elevated homocysteine levels, particularly to female patients, in this secondary analysis of a randomized controlled trial involving patients with minor ischemic stroke or TIA. TRIAL REGISTRATION ClinicalTrials.gov, no. NCT04078737.
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Affiliation(s)
- Anxin Wang
- Department of Neurology (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (A. Wang), Beijing, China; Department of Epidemiology and Health Statistics (Tian), School of Public Health, Capital Medical University, Beijing, China; Stroke Trials Unit, Mental Health and Clinical Neuroscience (Bath), University of Nottingham, Nottingham, UK; Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xue Tian
- Department of Neurology (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (A. Wang), Beijing, China; Department of Epidemiology and Health Statistics (Tian), School of Public Health, Capital Medical University, Beijing, China; Stroke Trials Unit, Mental Health and Clinical Neuroscience (Bath), University of Nottingham, Nottingham, UK; Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuewei Xie
- Department of Neurology (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (A. Wang), Beijing, China; Department of Epidemiology and Health Statistics (Tian), School of Public Health, Capital Medical University, Beijing, China; Stroke Trials Unit, Mental Health and Clinical Neuroscience (Bath), University of Nottingham, Nottingham, UK; Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- Department of Neurology (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (A. Wang), Beijing, China; Department of Epidemiology and Health Statistics (Tian), School of Public Health, Capital Medical University, Beijing, China; Stroke Trials Unit, Mental Health and Clinical Neuroscience (Bath), University of Nottingham, Nottingham, UK; Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Philip M Bath
- Department of Neurology (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (A. Wang), Beijing, China; Department of Epidemiology and Health Statistics (Tian), School of Public Health, Capital Medical University, Beijing, China; Stroke Trials Unit, Mental Health and Clinical Neuroscience (Bath), University of Nottingham, Nottingham, UK; Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing Jing
- Department of Neurology (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (A. Wang), Beijing, China; Department of Epidemiology and Health Statistics (Tian), School of Public Health, Capital Medical University, Beijing, China; Stroke Trials Unit, Mental Health and Clinical Neuroscience (Bath), University of Nottingham, Nottingham, UK; Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jinxi Lin
- Department of Neurology (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (A. Wang), Beijing, China; Department of Epidemiology and Health Statistics (Tian), School of Public Health, Capital Medical University, Beijing, China; Stroke Trials Unit, Mental Health and Clinical Neuroscience (Bath), University of Nottingham, Nottingham, UK; Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (A. Wang), Beijing, China; Department of Epidemiology and Health Statistics (Tian), School of Public Health, Capital Medical University, Beijing, China; Stroke Trials Unit, Mental Health and Clinical Neuroscience (Bath), University of Nottingham, Nottingham, UK; Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (A. Wang), Beijing, China; Department of Epidemiology and Health Statistics (Tian), School of Public Health, Capital Medical University, Beijing, China; Stroke Trials Unit, Mental Health and Clinical Neuroscience (Bath), University of Nottingham, Nottingham, UK; Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zixiao Li
- Department of Neurology (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (A. Wang), Beijing, China; Department of Epidemiology and Health Statistics (Tian), School of Public Health, Capital Medical University, Beijing, China; Stroke Trials Unit, Mental Health and Clinical Neuroscience (Bath), University of Nottingham, Nottingham, UK; Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liping Liu
- Department of Neurology (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (A. Wang), Beijing, China; Department of Epidemiology and Health Statistics (Tian), School of Public Health, Capital Medical University, Beijing, China; Stroke Trials Unit, Mental Health and Clinical Neuroscience (Bath), University of Nottingham, Nottingham, UK; Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (A. Wang), Beijing, China; Department of Epidemiology and Health Statistics (Tian), School of Public Health, Capital Medical University, Beijing, China; Stroke Trials Unit, Mental Health and Clinical Neuroscience (Bath), University of Nottingham, Nottingham, UK; Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- Department of Neurology (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (A. Wang, Tian, Xie, H. Li, Jing, Lin, Yilong Wang, Zhao, Z. Li, Liu, Yongjun Wang, Meng), Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (A. Wang), Beijing, China; Department of Epidemiology and Health Statistics (Tian), School of Public Health, Capital Medical University, Beijing, China; Stroke Trials Unit, Mental Health and Clinical Neuroscience (Bath), University of Nottingham, Nottingham, UK; Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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8
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Chen ZG, Shi X, Zhang XX, Yang FF, Li KR, Fang Q, Cao C, Chen XH, Peng Y. Neuron-secreted NLGN3 ameliorates ischemic brain injury via activating Gαi1/3-Akt signaling. Cell Death Dis 2023; 14:700. [PMID: 37880221 PMCID: PMC10600254 DOI: 10.1038/s41419-023-06219-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023]
Abstract
We here tested the potential activity and the underlying mechanisms of neuroligin-3 (NLGN3) against ischemia-reperfusion-induced neuronal cell injury. In SH-SY5Y neuronal cells and primary murine cortical neurons, NLGN3 activated Akt-mTOR and Erk signalings, and inhibited oxygen and glucose deprivation (OGD)/re-oxygenation (OGD/R)-induced cytotoxicity. Akt activation was required for NLGN3-induced neuroprotection. Gαi1/3 mediated NLGN3-induced downstream signaling activation. NLGN3-induced Akt-S6K1 activation was largely inhibited by Gαi1/3 silencing or knockout. Significantly, NLGN3-induced neuroprotection against OGD/R was almost abolished by Gαi1/3 silencing or knockout. In vivo, the middle cerebral artery occlusion (MCAO) procedure induced NLGN3 cleavage and secretion, and increased its expression and Akt activation in mouse brain tissues. ADAM10 (A Disintegrin and Metalloproteinase 10) inhibition blocked MCAO-induced NLGN3 cleavage and secretion, exacerbating ischemic brain injury in mice. Neuronal silencing of NLGN3 or Gαi1/3 in mice also inhibited Akt activation and intensified MCAO-induced ischemic brain injury. Conversely, neuronal overexpression of NLGN3 increased Akt activation and alleviated MCAO-induced ischemic brain injury. Together, NLGN3 activates Gαi1/3-Akt signaling to protect neuronal cells from ischemia-reperfusion injury.
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Affiliation(s)
- Zhi-Guo Chen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xin Shi
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Institute of Neuroscience, Soochow University, Suzhou, China
| | - Xian-Xian Zhang
- Department of Neurology, Affiliated Hospital 6 of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - Fang-Fang Yang
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Institute of Neuroscience, Soochow University, Suzhou, China
| | - Ke-Ran Li
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Institute of Neuroscience, Soochow University, Suzhou, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Cong Cao
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Institute of Neuroscience, Soochow University, Suzhou, China.
| | - Xiong-Hui Chen
- Department of Emergency Surgery, First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Ya Peng
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou, China.
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9
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Liu TT, Shi X, Hu HW, Chen JP, Jiang Q, Zhen YF, Cao C, Liu XW, Liu JG. Endothelial cell-derived RSPO3 activates Gαi1/3-Erk signaling and protects neurons from ischemia/reperfusion injury. Cell Death Dis 2023; 14:654. [PMID: 37805583 PMCID: PMC10560285 DOI: 10.1038/s41419-023-06176-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023]
Abstract
The current study explores the potential function and the underlying mechanisms of endothelial cell-derived R-spondin 3 (RSPO3) neuroprotection against ischemia/reperfusion-induced neuronal cell injury. In both neuronal cells (Neuro-2a) and primary murine cortical neurons, pretreatment with RSPO3 ameliorated oxygen and glucose deprivation (OGD)/re-oxygenation (OGD/R)-induced neuronal cell death and oxidative injury. In neurons RSPO3 activated the Akt, Erk and β-Catenin signaling cascade, but only Erk inhibitors reversed RSPO3-induced neuroprotection against OGD/R. In mouse embryonic fibroblasts (MEFs) and neuronal cells, RSPO3-induced LGR4-Gab1-Gαi1/3 association was required for Erk activation, and either silencing or knockout of Gαi1 and Gαi3 abolished RSPO3-induced neuroprotection. In mice, middle cerebral artery occlusion (MCAO) increased RSPO3 expression and Erk activation in ischemic penumbra brain tissues. Endothelial knockdown or knockout of RSPO3 inhibited Erk activation in the ischemic penumbra brain tissues and increased MCAO-induced cerebral ischemic injury in mice. Conversely, endothelial overexpression of RSPO3 ameliorated MCAO-induced cerebral ischemic injury. We conclude that RSPO3 activates Gαi1/3-Erk signaling to protect neuronal cells from ischemia/reperfusion injury.
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Affiliation(s)
- Ting-Tao Liu
- Shandong University, Department of Neurology, Shandong Provincial Hospital, Jinan, China
- Department of Neurology, Shouguang Hospital of T.C.M, Shouguang, China
| | - Xin Shi
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Hong-Wei Hu
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ju-Ping Chen
- Department of Neurology, Changshu Hospital of Traditional Chinese Medicine, Changshu, China
| | - Qin Jiang
- The Fourth School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Yun-Fang Zhen
- Department of Orthopedics, Children's hospital of Soochow University, Suzhou, China.
| | - Cong Cao
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China.
| | - Xue-Wu Liu
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
| | - Jian-Gang Liu
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
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10
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Purroy F, Ois A, Jove M, Arque G, Sol J, Mauri-Capdevila G, Rodriguez-Campello A, Pamplona R, Portero M, Roquer J. Lipidomic signature of stroke recurrence after transient ischemic attack. Sci Rep 2023; 13:13706. [PMID: 37607967 PMCID: PMC10444771 DOI: 10.1038/s41598-023-40838-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 08/17/2023] [Indexed: 08/24/2023] Open
Abstract
While TIA patients have transient symptoms, they should not be underestimated, as they could have an underlying pathology that may lead to a subsequent stroke: stroke recurrence (SR). Previously, it has been described the involvement of lipids in different vascular diseases. The aim of the current study was to perform a lipidomic analysis to identify differences in the lipidomic profile between patients with SR and patients without. Untargeted lipidomic analysis was performed in plasma samples of 460 consecutive TIA patients recruited < 24 h after the onset of symptoms. 37 (8%) patients suffered SR at 90 days. Lipidomic profiling disclosed 7 lipid species differentially expressed between groups: 5 triacylglycerides (TG), 1 diacylglyceride (DG), and 1 alkenyl-PE (plasmalogen) [specifically, TG(56:1), TG(63:0), TG(58:2), TG(50:5), TG(53:7, DG(38:5)) and PE(P-18:0/18:2)]. 6 of these 7 lipid species belonged to the glycerolipid family and a plasmalogen, pointing to bioenergetics pathways, as well as oxidative stress response. In this context, it was proposed the PE(P-18:0/18:2) as potential biomarker of SR condition.The observed changes in lipid patterns suggest pathophysiological mechanisms associated with lipid droplets metabolism and antioxidant protection that is translated to plasma level as consequence of a more intensive or high-risk ischemic condition related to SR.
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Affiliation(s)
- F Purroy
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, UdL, Lleida, Spain.
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova, Avda Rovira Roure 80, 25198, Lleida, Spain.
| | - A Ois
- Department of Neurology, Neurology Neurovascular Research Unit Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - M Jove
- Experimental Medicine Department, Lleida University-Lleida Biomedical Research Institute (UdL-IRBLleida), 25198, Lleida, Spain
| | - G Arque
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, UdL, Lleida, Spain
| | - J Sol
- Institut Català de la Salut (ICS), Atenció Primària, Lleida, Spain
- Research Support Unit Lleida, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Lleida, Spain
| | - G Mauri-Capdevila
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, UdL, Lleida, Spain
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova, Avda Rovira Roure 80, 25198, Lleida, Spain
| | - A Rodriguez-Campello
- Department of Neurology, Neurology Neurovascular Research Unit Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - R Pamplona
- Experimental Medicine Department, Lleida University-Lleida Biomedical Research Institute (UdL-IRBLleida), 25198, Lleida, Spain
| | - M Portero
- Experimental Medicine Department, Lleida University-Lleida Biomedical Research Institute (UdL-IRBLleida), 25198, Lleida, Spain
| | - J Roquer
- Department of Neurology, Neurology Neurovascular Research Unit Hospital del Mar Research Institute (IMIM), Barcelona, Spain
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11
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Li M, Yang Q, Shi J, Zhang X, Lin H, Ge F. Ticagrelor plus aspirin in patients with minor ischemic stroke and transient ischemic attack: a network meta-analysis. BMC Neurol 2023; 23:303. [PMID: 37580668 PMCID: PMC10424353 DOI: 10.1186/s12883-023-03356-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel was recommended as the secondary prevention of minor ischemic stroke or transient ischaemic attack (TIA). However, genetic polymorphisms of CYP2C19 had been identified as the major cause of poor responsiveness to clopidogrel. Ticagrelor, unlike clopidogrel, did not depend on metabolic activation, but it remained unclear whether ticagrelor was superior to clopidogrel in ischemic stroke. We performed a network meta-analysis to compare the efficacy and safety of ticagrelor, clopidogrel, and aspirin in the minor ischemic stroke and TIA populations. METHODS Databases of Cochrane Library, ClinicalTrials.gov, and PubMed were searched up to June 19, 2023. Randomized controlled trials (RCTs) assessing antiplatelet drugs for minor stroke or TIA were included. Statistical processing was conducted by using multivariate meta-analysis routines of STATA. RESULTS Seven RCTs were included involving 41,745 participants. There was no significant difference between the two DAPTs in preventing stroke recurrence (OR, 1.16; 95% CI, 0.93-1.44), ischemic stroke recurrence (OR, 1.16; 95% CI, 0.93-1.45), and major hemorrhage (OR, 1.22; 95% CI, 0.62,2.39). Compared with aspirin alone, the two DAPT regimen reduced the risk of stroke recurrence (clopidogrel: OR, 0.69; 95% CI, 0.60-0.80, ticagrelor: OR, 0.66; 95% CI, 0.49-0.87) and ischemic stroke recurrence, but increased the incidence of major hemorrhage (clopidogrel: OR, 2.05; 95% CI, 1.22- 3.77; ticagrelor: OR, 2.55; 95% CI, 1.25-4.99). Despite being associated with a higher risk of any bleeding, ticagrelor did not impact the composite of vascular events or mortality. While ticagrelor and aspirin reduced the risk of ischemic stroke recurrence (OR, 0.77; 95% CI, 0.63- 0.92) without increasing the risk of major bleeding (OR 0.94; 95% CI 0.45-1.95) in the Asian population mainly Chinese. CONCLUSIONS DAPT was superior to aspirin in stroke prevention, but little difference existed between the two DAPT regimens. Asian population mainly Chinese may benefit from DAPT with aspirin and ticagrelor. But further head-to-head RCTs are needed to validate the study results.
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Affiliation(s)
- Mingxia Li
- Department of Neurology, Xi'an International Medical Center Hospital, Xitai Road, Gaoxin District, Xi'an City, 710010, Shaanxi Province, China
| | - Qianru Yang
- Department of Neurology, Xi'an International Medical Center Hospital, Xitai Road, Gaoxin District, Xi'an City, 710010, Shaanxi Province, China
| | - Jiankuan Shi
- Department of Neurology, Xi'an International Medical Center Hospital, Xitai Road, Gaoxin District, Xi'an City, 710010, Shaanxi Province, China
| | - Xiaolong Zhang
- Department of Neurology, Xi'an International Medical Center Hospital, Xitai Road, Gaoxin District, Xi'an City, 710010, Shaanxi Province, China
| | - Hong Lin
- Department of Neurology, Xi'an International Medical Center Hospital, Xitai Road, Gaoxin District, Xi'an City, 710010, Shaanxi Province, China.
| | - Fangfang Ge
- Department of Neurology, Xi'an International Medical Center Hospital, Xitai Road, Gaoxin District, Xi'an City, 710010, Shaanxi Province, China.
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12
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1047] [Impact Index Per Article: 1047.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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13
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Wang A, Meng X, Tian X, Zuo Y, Bath PM, Li H, Xie X, Jing J, Lin J, Wang Y, Zhao X, Liu L, Li Z, Jiang Y, Xu J, Wang F, Chen W, Cao M, Li J, Wang Y. Ticagrelor Aspirin vs Clopidogrel Aspirin in CYP2C19 Loss-of-Function Carriers With Minor Stroke or TIA Stratified by Risk Profile. Neurology 2023; 100:e497-e504. [PMID: 36535779 PMCID: PMC9931078 DOI: 10.1212/wnl.0000000000201454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE 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.
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Affiliation(s)
- Anxin Wang
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Xia Meng
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Xue Tian
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Yingting Zuo
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Philip M Bath
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Hao Li
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Xuewei Xie
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Jing Jing
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Jinxi Lin
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Yilong Wang
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Xingquan Zhao
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Liping Liu
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Zixiao Li
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Yong Jiang
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Jie Xu
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Feng Wang
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Weifeng Chen
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Minghua Cao
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Jianhua Li
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Yongjun Wang
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China.
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14
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Jing J, Xie X, Johnston SC, Bath PM, Li Z, Zhao X, Liu L, Wang Y, Xu Q, Wang A, Jiang Y, Li H, Meng X, Wang Y. Genotype-Guided Dual Antiplatelet Use for Transient Ischemic Attack and Minor Stroke by Imaging Status: Subgroup Analysis of the CHANCE-2 Trial. Ann Neurol 2022; 93:783-792. [PMID: 36571569 DOI: 10.1002/ana.26589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study was performed to investigate whether ticagrelor/aspirin versus clopidogrel/aspirin can further reduce the residual risk of stroke recurrence in patients with positive diffusion-weighted imaging (DWI) in the High-Risk Patients with Acute Nondisabling Cerebrovascular Events II (CHANCE-2) trial. METHODS Patients with DWI data in the CHANCE-2 trial were included and divided into those with and without acute infarction according to their DWI findings. The primary efficacy outcome and safety outcome were stroke recurrence and moderate to severe bleeding within 3 months of follow-up, respectively. RESULTS Of the 6,412 patients enrolled in the CHANCE-2 trial, 5,796 (90.4%) patients with DWI data were included in the subgroup analysis. A total of 4,369 patients (75.4%) had an acute infarction on DWI. Patients with positive DWI had higher risk of recurrent stroke (8.1%) than those without infarction (2.2%) within 3-month follow-up. Compared with clopidogrel/aspirin, ticagrelor/aspirin was associated with lower risk of stroke in patients with positive DWI (hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.52-0.80, p < 0.001) than in those negative DWI (HR = 1.22, 95% CI = 0.55-2.72, p = 0.63), with a significant interaction association (p for interaction = 0.049). The risk of moderate to severe bleeding was similar between ticagrelor/aspirin and clopidogrel/aspirin treatment in the different groups. INTERPRETATION Our study demonstrates that imaging evaluation should be emphasized before targeting the best candidates for genotype-guided dual antiplatelet therapy in future clinical research and practice. ANN NEUROL 2023.
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Affiliation(s)
- Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Tiantan Neuroimaging Center of Excellence, Beijing, China
| | - Xuewei Xie
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | | | - Philip M Bath
- Stroke Trials Unit, Mental Health and Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Qin Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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15
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Circulating MicroRNA Profiling Identifies Distinct MicroRNA Signatures in Acute Ischemic Stroke and Transient Ischemic Attack Patients. Int J Mol Sci 2022; 24:ijms24010108. [PMID: 36613546 PMCID: PMC9820644 DOI: 10.3390/ijms24010108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/04/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
Transient ischemic attack (TIA) refers to a momentary neurologic deficit caused by focal cerebral, spinal or retinal ischemic insult. TIA is associated with a high risk of impending acute ischemic stroke (AIS), a neurologic dysfunction characterized by focal cerebral, spinal or retinal infarction. Understanding the differences in molecular pathways in AIS and TIA has merit for deciphering the underlying cause for neuronal deficits with long-term effects and high risks of morbidity and mortality. In this study, we performed comprehensive investigations into the circulating microRNA (miRNA) profiles of AIS (n = 191) and TIA (n = 61) patients. We performed RNA-Seq on serum samples collected within 24 hrs of clinical diagnosis and randomly divided the study populations into discovery and validation cohorts. We identified a panel of 11 differentially regulated miRNAs at FDR < 0.05. Hsa-miR-548c-5p, -20a-5p, -18a-5p, -484, -652-3p, -486-3p, -24-3p, -181a-5p and -222-3p were upregulated, while hsa-miR-500a-3p and -206 were downregulated in AIS patients compared to TIA patients. We also probed the previously validated gene targets of our identified miRNA panel to highlight the molecular pathways affected in AIS. Moreover, we developed a multivariate classifier with potential utilization as a discriminative biomarker for AIS and TIA patients. The underlying molecular pathways in AIS compared to TIA may be explored further in functional studies for therapeutic targeting in clinical translation.
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Caspers M, Holle JF, Limper U, Fröhlich M, Bouillon B. Global Coagulation Testing in Acute Care Medicine: Back to Bedside? Hamostaseologie 2022; 42:400-408. [PMID: 36549292 DOI: 10.1055/a-1938-1984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Detailed and decisive information about the patients' coagulation status is important in various emergency situations. Conventional global coagulation testing strategies are often used to provide a quick overview, but several limitations particularly in the trauma setting are well described. With the introduction of direct oral anticoagulations (DOACs), a milestone for several disease entities resulting in overall improved outcomes could be reached, but at the same time providing new diagnostic challenges for the emergency situation. DESIGN As an alternative to conventional coagulation tests, there is increasing clinical and scientific interest in the use of early whole blood strategies to provide goal-directed coagulation therapies (GDCT) and hemostatic control in critically ill patients. Viscoelastic hemostatic assays (VHAs) were therefore introduced to several clinical applications and may provide as a bedside point-of-care method for faster information on the underlying hemostatic deficiency. CONCLUSION The use of VHA-based algorithms to guide hemostatic control in emergency situations now found its way to several international guidelines for patients at risk of bleeding. With this qualitative review, we would like to focus on VHA-based GDCT and review the current evidence for its use, advantages, and challenges in the two different clinical scenarios of trauma and intracerebral bleeding/stroke management.
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Affiliation(s)
- Michael Caspers
- Department of Medicine, The Institute for Research in Operative Medicine, Faculty of Health, Witten/Herdecke University, Cologne, Germany.,Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Cologne, Germany
| | - Johannes Fabian Holle
- Department of Neurology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Cologne, Germany
| | - Ulrich Limper
- Department of Anaesthesiology and Intensive Care Medicine, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Cologne, Germany
| | - Matthias Fröhlich
- Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Cologne, Germany
| | - Bertil Bouillon
- Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Cologne, Germany
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Altered Effective Connectivity of the Primary Motor Cortex in Transient Ischemic Attack. Neural Plast 2022; 2022:2219993. [PMID: 36437903 PMCID: PMC9699783 DOI: 10.1155/2022/2219993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/02/2022] [Accepted: 09/19/2022] [Indexed: 11/19/2022] Open
Abstract
Objective This study is aimed at exploring alteration in motor-related effective connectivity in individuals with transient ischemic attack (TIA). Methods A total of 48 individuals with TIA and 41 age-matched and sex-matched healthy controls (HCs) were recruited for this study. The participants were scanned using MRI, and their clinical characteristics were collected. To investigate motor-related effective connectivity differences between individuals with TIA and HCs, the bilateral primary motor cortex (M1) was used as the regions of interest (ROIs) to perform a whole-brain Granger causality analysis (GCA). Furthermore, partial correlation was used to evaluate the relationship between GCA values and the clinical characteristics of individuals with TIA. Results Compared with HCs, individuals with TIA demonstrated alterations in the effective connectivity between M1 and widely distributed brain regions involved in motor, visual, auditory, and sensory integration. In addition, GCA values were significantly correlated with high- and low-density lipoprotein cholesterols in individuals with TIA. Conclusion This study provides important evidence for the alteration of motor-related effective connectivity in TIA, which reflects the abnormal information flow between different brain regions. This could help further elucidate the pathological mechanisms of motor impairment in individuals with TIA and provide a new perspective for future early diagnosis and intervention for TIA.
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Duan R, Sun K, Fang F, Wang N, He R, Gao Y, Jing L, Li Y, Gong Z, Yao Y, Luan T, Zhang C, Zhang J, Zhao Y, Xie H, Zhou Y, Teng J, Zhang J, Jia Y. An ischemia-homing bioengineered nano-scavenger for specifically alleviating multiple pathogeneses in ischemic stroke. J Nanobiotechnology 2022; 20:397. [PMID: 36045405 PMCID: PMC9429703 DOI: 10.1186/s12951-022-01602-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/22/2022] [Indexed: 11/20/2022] Open
Abstract
Background Ischemic stroke is one of the most serious global public health problems. However, the performance of current therapeutic regimens is limited due to their poor target specificity, narrow therapeutic time window, and compromised therapeutic effect. To overcome these barriers, we designed an ischemia-homing bioengineered nano-scavenger by camouflaging a catalase (CAT)-loaded self-assembled tannic acid (TA) nanoparticle with a M2-type microglia membrane (TPC@M2 NPs) for ischemic stroke treatment. Results The TPC@M2 NPs can on-demand release TA molecules to chelate excessive Fe2+, while acid-responsively liberating CAT to synergistically scavenge multiple ROS (·OH, ·O2−, and H2O2). Besides, the M2 microglia membrane not only can be served as bioinspired therapeutic agents to repolarize M1 microglia into M2 phenotype but also endows the nano-scavenger with ischemia-homing and BBB-crossing capabilities. Conclusions The nano-scavenger for specific clearance of multiple pathogenic elements to alleviate inflammation and protect neurons holds great promise for combating ischemic stroke and other inflammation-related diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12951-022-01602-7.
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Affiliation(s)
- Ranran Duan
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Ke Sun
- Department of Urinary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
| | - Fang Fang
- Key Laboratory of Molecular Medicine and Biotherapy, School of Life Sciences, Beijing Institute of Technology, Beijing, 100811, China
| | - Ning Wang
- Department of Biochemistry, College of Life Sciences, Shaanxi Normal University, Xi'an, 710062, Shanxi, China
| | - Ruya He
- The International Medical Center, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yang Gao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Lijun Jing
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yanfei Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Zhe Gong
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yaobing Yao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Tingting Luan
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Chaopeng Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Jinwei Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yi Zhao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Haojie Xie
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yongyan Zhou
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Junfang Teng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Jinfeng Zhang
- Key Laboratory of Molecular Medicine and Biotherapy, School of Life Sciences, Beijing Institute of Technology, Beijing, 100811, China.
| | - Yanjie Jia
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
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Chen P, Wu Q, Xie X, Jing J, Gu H, Wang X, Meng X, Liu L, Wang Y, Wang Y. Systolic blood pressure and recurrent stroke in patients with different lesion patterns on diffusion weighted imaging. J Clin Hypertens (Greenwich) 2022; 24:1350-1357. [PMID: 35959564 PMCID: PMC9581100 DOI: 10.1111/jch.14543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/28/2022]
Abstract
Little is known about the relationship between baseline systolic blood pressure (SBP) and subsequent clinical events in patients with different lesion patterns on diffusion weighted imaging (DWI). We analyzed the Acute Non‐disabling Cerebrovascular Events (CHANCE) trial dataset. Patients were categorized into negative DW imaging (no detectable lesions), lacunar infarction (single lesion ≤15 mm) and non‐lacunar infarction (single lesion >15 mm or multiple lesions) based on lesion patterns on DWI. The primary outcome was recurrent stroke within 90 days. Cox proportional hazards models were used to assess the association between SBP levels and stroke outcomes in patients with different lesion patterns. A total of 1089 patients were analyzed. We found 258 cases (23.7%) with negative DW imaging, 392 (36.0%) with lacunar infarction and 439 (40.3%) with non‐lacunar infarction. Patients with non‐lacunar infarction had the highest incidence of stroke at 90‐day (P < .001). In non‐lacunar infarction group, compared with SBP < 160 mmHg, patients with SBP ≥ 160 mmHg had significantly higher risk of 90‐day recurrent stroke (20.3% vs. 10.7%; adjusted hazard ratio 1.81, 95% confidence interval 1.09–3.00). No significant association was found between SBP and clinical outcomes in patients with negative DWI and lacunar stroke groups. The result at 1 year was similar as at 90‐day. Therefore, non‐lacunar infarction, the most common lesion pattern in CHANCE study, had the highest risk of recurrent stroke and combined vascular events both in 90 days and 1 year. High baseline SBP was significantly associated with increased risk of short‐ and long‐term recurrent strokes in patients with non‐lacunar infarction.
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Affiliation(s)
- Pan Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Qiong Wu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.,Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Xuewei Xie
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongqiu Gu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Xianwei Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
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Risk Factors and Distribution Characteristics of Intracranial and Intracranial Artery Stenosis in Young Sufferers with Ischemic Stroke. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:9684158. [PMID: 35845727 PMCID: PMC9249471 DOI: 10.1155/2022/9684158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/04/2022] [Accepted: 06/09/2022] [Indexed: 11/18/2022]
Abstract
In order to explore the risk factors of intracranial and intracranial arterial stenosis, the distribution of young ischemic stroke sufferers with intracranial and intracranial arterial stenosis and the related are analyzed. In this study, a total of 213 young sufferers with ischemic stroke (IS) admitted to our hospital from February 2019 to September 2021 are selected. According to the CT diagnosis of intracranial artery stenosis (AS), 213 patients are divided into two groups, with 86 in the AS Group and 127 in the non-AS Group. To analyze the distribution of intracranial and intracranial AS in young patients with ischemic stroke, 86 patients with AS are examined by carotid B-mode ultrasound. Furthermore, a univariate analysis is performed on the relevant indicators of the sufferers in the cancer (CA) set and the two sets without CA, and then, the indicators with statistically extensive disparity were selected for multivariate logistic regression analysis of the risk factors for CA symptoms. The results show 50% of the sufferers with moderate or severe ischemic CA in young adults and 63.95% of the sufferers with intracranial artery stenosis. It is clearly evident that the main risk factors affecting the occurrence of intracranial and intracranial arteries in young IS are hypertension and long-term smoking, long-term drinking, and hyperlipidemia.
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Pan Y, Meng X, Jin A, Johnston SC, Li H, Bath PM, Xie X, Jing J, Lin J, Wang Y, Zhao X, Li Z, Jiang Y, Liu L, Yang H, Cheng J, Wang Z, Wang Y. Time Course for Benefit and Risk With Ticagrelor and Aspirin in Individuals With Acute Ischemic Stroke or Transient Ischemic Attack Who Carry CYP2C19 Loss-of-Function Alleles: A Secondary Analysis of the CHANCE-2 Randomized Clinical Trial. JAMA Neurol 2022; 79:739-745. [PMID: 35727586 DOI: 10.1001/jamaneurol.2022.1457] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Dual antiplatelet therapy (DAPT) with ticagrelor and aspirin has been found to be effective for secondary prevention after minor ischemic stroke or transient ischemic attack (TIA) in individuals who carry CYP2C19 loss-of-function (LOF) alleles; however, uncertainties remain about the time course of benefit and risk with ticagrelor and aspirin in these patients. Objective To obtain time-course estimates of efficacy and risk with ticagrelor and aspirin after minor stroke or TIA in individuals with CYP2C19 LOF alleles. Design, Setting, and Participants The Ticagrelor or Clopidogrel With Aspirin in High-risk Patients With Acute Nondisabling Cerebrovascular Events II (CHANCE-2) randomized clinical trial enrolled patients 40 years and older from 202 hospitals in China with acute minor stroke or TIA who carried CYP2C19 LOF alleles between September 23, 2019, and March 22, 2021, and were followed up for 90 days. All 6412 patients enrolled in the CHANCE-2 trial were included in this secondary analysis. Data were analyzed in October 2021. Interventions Ticagrelor (180 mg on day 1 followed by 90 mg twice daily on days 2-90) or clopidogrel (300 mg on day 1 followed by 75 mg daily on days 2-90). All patients received aspirin (75-300 mg on day 1 followed by 75 mg daily for 21 days). Main Outcomes and Measures The efficacy outcome was major ischemic event, defined as the composite of ischemic stroke or nonhemorrhagic death. Safety outcomes included moderate to severe bleeding and any bleeding. Results A total of 6412 patients were included (3205 in the ticagrelor and aspirin group and 3207 in the clopidogrel and aspirin group). The median (IQR) age was 65 (57-71) years, and 4242 patients (66%) were men. The reduction of major ischemic events with ticagrelor and aspirin predominately occurred in the first week (absolute risk reduction, 1.34%; 95% CI, 0.29 to 2.39) and attenuated but remained in the next 3 weeks (absolute risk reduction in the second week, 0.11%; 95% CI, -0.24 to 0.45; absolute risk reduction in the third week, 0.14%; 95% CI, -0.11 to 0.38; absolute risk reduction in the fourth week, 0.04%; 95% CI, -0.18 to 0.25). The risk of moderate to severe bleeding was consistently low in the ticagrelor and aspirin group. The absolute increase in any bleeding seen in the first week (0.87%; 95% CI, 0.25 to 1.50) remained in the next 3 weeks (absolute increase in the second week, 1.21%; 95% CI, 0.75 to 1.68; absolute increase in the third week, 0.33%; 95% CI, -0.05 to 0.72; absolute increase in the fourth week, 0.23%; 95% CI, -0.03 to 0.49). Conclusion and Relevance Among patients with minor stroke or TIA who carried CYP2C19 LOF alleles, benefit with ticagrelor and aspirin was present predominately in the first week, with additional small benefit accruing in the next 2 weeks.
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Affiliation(s)
- Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Aoming Jin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | | | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Philip M Bath
- Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Xuewei Xie
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jinxi Lin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hongqin Yang
- Department of Neurology, Jiyuan Hospital of Traditional Chinese Medicine, Henan, China
| | - Jiwei Cheng
- Department of Neurology, Putuo District Central Hospital, Shanghai, China
| | - Zhimin Wang
- Department of Neurology, Taizhou First People's Hospital, Zhejiang, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
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Wang A, Meng X, Tian X, Johnston SC, Li H, Bath PM, Zuo Y, Xie X, Jing J, Lin J, Wang Y, Zhao X, Li Z, Jiang Y, Liu L, Wang F, Wang Y, Huang P, Chen G, Wang Y. Effect of Hypertension on Efficacy and Safety of Ticagrelor-Aspirin Versus Clopidogrel-Aspirin in Minor Stroke or Transient Ischemic Attack. Stroke 2022; 53:2799-2808. [PMID: 35656824 DOI: 10.1161/strokeaha.122.038662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND 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: http://www. CLINICALTRIALS gov; Unique identifier: NCT04078737.
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Affiliation(s)
- Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang)
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang)
| | - Xue Tian
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China (X.T., Y.Z.).,Beijing Municipal Key Laboratory of Clinical Epidemiology, China (X.T., Y.Z.)
| | | | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang)
| | - Philip M Bath
- Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, United Kingdom (P.M.B.)
| | - Yingting Zuo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China (X.T., Y.Z.).,Beijing Municipal Key Laboratory of Clinical Epidemiology, China (X.T., Y.Z.)
| | - Xuewei Xie
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang)
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang)
| | - Jinxi Lin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang)
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang)
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang)
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang)
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang)
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang)
| | - Feng Wang
- Departments of Neurology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, China (F.W.)
| | - Yanxia Wang
- Department of Neurology, Hejian People's Hospital, Hebei, China (Y.W.)
| | - Panbing Huang
- Department of Neurology, The third People's Hospital in Tongzhou District of Nantong, Jiangsu, China (P.H.)
| | - Guofang Chen
- Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.)
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, China. (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang)
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23
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Wang Y, Pan Y, Li H, Amarenco P, Denison H, Evans SR, Himmelmann A, James S, Knutsson M, Ladenvall P, Molina CA, Johnston SC. Time Course for Benefit and Risk of Ticagrelor and Aspirin in Acute Ischemic Stroke or Transient Ischemic Attack. Neurology 2022; 99:e46-e54. [PMID: 35437261 PMCID: PMC9259092 DOI: 10.1212/wnl.0000000000200355] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/21/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To investigate the short-term time course benefit and risk of ticagrelor with aspirin in acute mild-moderate ischemic stroke or high-risk transient ischemic attack (TIA) in the THALES (The Acute Stroke or Transient Ischemic Attack Treated with Ticagrelor and ASA for Prevention of Stroke and Death) trial. METHODS In an exploratory analysis of the THALES trial, we evaluated the cumulative incidence of irreversible efficacy and safety outcomes at different timepoints during the 30-day treatment period. The efficacy outcome was major ischemic events defined as a composite of ischemic stroke or non-hemorrhagic death. The safety outcome was major hemorrhage defined as a composite of intracranial hemorrhage and fatal bleedings. Net clinical impact was defined as the combination of these two endpoints. RESULTS This analysis included a total of 11,016 patients (5523 in the ticagrelor-aspirin group and 5493 in the aspirin group) with mean age of 65 years, and 39% were women. The reduction of major ischemic events by ticagrelor occurred in the first week (4.1% vs 5.3%; absolute risk reduction 1.15%, 95% CI 0.36% to 1.94%), and remained throughout the 30-day treatment period. An increase in major hemorrhage was seen during the first week and remained relatively constant in the following weeks (absolute risk increase, approximately 0.3%). Cumulative analysis showed that the net clinical impact favored ticagrelor-aspirin in the first week (absolute risk reduction 0.97%, 95% CI, 0.17% to 1.77%) and remained constant throughout the 30 days. DISCUSSION In patients with mild-moderate ischemic stroke or high-risk TIA, the treatment effect of ticagrelor-aspirin was present from the first week. The ischemic benefit of ticagrelor-aspirin outweighs the risk of major hemorrhage throughout the treatment period, which may support the use of 30 days treatment with ticagrelor and aspirin in these patients. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for patients with mild-moderate ischemic stroke or high-risk TIA, the ischemic benefit of ticagrelor-aspirin outweighs the risk of major hemorrhage throughout the 30-day treatment period.
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Affiliation(s)
- Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Pierre Amarenco
- Department of Neurology and Stroke Center, Bichat-Claude Bernard Hospital, University of Paris, Paris, France
| | - Hans Denison
- Biopharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
| | - Scott R Evans
- Biostatistics Center, George Washington University, Washington, DC, USA
| | - Anders Himmelmann
- Biopharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
| | - Stefan James
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Mikael Knutsson
- Biopharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
| | - Per Ladenvall
- Biopharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
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24
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Nouri-Vaskeh M, Khalili N, Sadighi A, Yazdani Y, Zand R. Biomarkers for Transient Ischemic Attack: A Brief Perspective of Current Reports and Future Horizons. J Clin Med 2022; 11:jcm11041046. [PMID: 35207321 PMCID: PMC8877275 DOI: 10.3390/jcm11041046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 02/05/2023] Open
Abstract
Cerebrovascular disease is the leading cause of long-term disability in the world and the third-leading cause of death in the United States. The early diagnosis of transient ischemic attack (TIA) is of great importance for reducing the mortality and morbidity of cerebrovascular diseases. Patients with TIA have a high risk of early subsequent ischemic stroke and the development of permanent nervous system lesions. The diagnosis of TIA remains a clinical diagnosis that highly relies on the patient's medical history assessment. There is a growing list of biomarkers associated with different components of the ischemic cascade in the brain. In this review, we take a closer look at the biomarkers of TIA and their validity with a focus on the more clinically important ones using recent evidence of their reliability for practical usage.
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Affiliation(s)
- Masoud Nouri-Vaskeh
- Tropical and Communicable Diseases Research Centre, Iranshahr University of Medical Sciences, Iranshahr 7618815676, Iran;
- Network of Immunity in Infection, Malignancy and Autoimmunity, Universal Scientific Education and Research Network, Tehran 1419733151, Iran
| | - Neda Khalili
- School of Medicine, Tehran University of Medical Sciences, Tehran 1449614535, Iran;
- Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Tehran 1419733151, Iran
| | - Alireza Sadighi
- Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA;
| | - Yalda Yazdani
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz 5165665931, Iran;
| | - Ramin Zand
- Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA;
- Neuroscience Institute, Pennsylvania State University, State College, PA 16801, USA
- Correspondence: or ; Tel.: +1-570-808-7330; Fax: +1-570-808-3209
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25
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Tomari S, Levi CR, Holliday E, Lasserson D, Valderas JM, Dewey HM, Barber PA, Spratt NJ, Cadilhac DA, Feigin VL, Rothwell PM, Zareie H, Garcia-Esperon C, Davey A, Najib N, Sales M, Magin P. One-Year Risk of Stroke After Transient Ischemic Attack or Minor Stroke in Hunter New England, Australia (INSIST Study). Front Neurol 2022; 12:791193. [PMID: 34987471 PMCID: PMC8721144 DOI: 10.3389/fneur.2021.791193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: One-year risk of stroke in transient ischemic attack and minor stroke (TIAMS) managed in secondary care settings has been reported as 5-8%. However, evidence for the outcomes of TIAMS in community care settings is limited. Methods: The INternational comparison of Systems of care and patient outcomes In minor Stroke and TIA (INSIST) study was a prospective inception cohort community-based study of patients of 16 general practices in the Hunter-Manning region (New South Wales, Australia). Possible-TIAMS patients were recruited from 2012 to 2016 and followed-up for 12 months post-index event. Adjudication as TIAMS or TIAMS-mimics was by an expert panel. We established 7-days, 90-days, and 1-year risk of stroke, TIA, myocardial infarction (MI), coronary or carotid revascularization procedure and death; and medications use at 24 h post-index event. Results: Of 613 participants (mean age; 70 ± 12 years), 298 (49%) were adjudicated as TIAMS. TIAMS-group participants had ischemic strokes at 7-days, 90-days, and 1-year, at Kaplan-Meier (KM) rates of 1% (95% confidence interval; 0.3, 3.1), 2.1% (0.9, 4.6), and 3.2% (1.7, 6.1), respectively, compared to 0.3, 0.3, and 0.6% of TIAMS-mimic-group participants. At one year, TIAMS-group-participants had twenty-five TIA events (KM rate: 8.8%), two MI events (0.6%), four coronary revascularizations (1.5%), eleven carotid revascularizations (3.9%), and three deaths (1.1%), compared to 1.6, 0.6, 1.0, 0.3, and 0.6% of TIAMS-mimic-group participants. Of 167 TIAMS-group participants who commenced or received enhanced therapies, 95 (57%) were treated within 24 h post-index event. For TIAMS-group participants who commenced or received enhanced therapies, time from symptom onset to treatment was median 9.5 h [IQR 1.8-89.9]. Conclusion: One-year risk of stroke in TIAMS participants was lower than reported in previous studies. Early implementation of antiplatelet/anticoagulant therapies may have contributed to the low stroke recurrence.
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Affiliation(s)
- Shinya Tomari
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Christopher R Levi
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.,Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Elizabeth Holliday
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Daniel Lasserson
- Warwick Medical School, University of Warwick, Warwick, United Kingdom
| | - Jose M Valderas
- Health Service and Policy Research Group, University of Exeter, Exeter, United Kingdom
| | - Helen M Dewey
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - P Alan Barber
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Neil J Spratt
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.,Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Peter M Rothwell
- Nuffield Department of Clinical Neuroscience, Centre for Prevention of Stroke and Dementia, University of Oxford, Oxford, United Kingdom
| | - Hossein Zareie
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Carlos Garcia-Esperon
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.,Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Andrew Davey
- Discipline of General Practice, University of Newcastle, Newcastle, NSW, Australia
| | - Nashwa Najib
- Discipline of General Practice, University of Newcastle, Newcastle, NSW, Australia
| | - Milton Sales
- Brunker Road General Practice, Newcastle, NSW, Australia
| | - Parker Magin
- Discipline of General Practice, University of Newcastle, Newcastle, NSW, Australia
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26
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Shahjouei S, Li J, Koza E, Abedi V, Sadr AV, Chen Q, Mowla A, Griffin P, Ranta A, Zand R. Risk of Subsequent Stroke Among Patients Receiving Outpatient vs Inpatient Care for Transient Ischemic Attack: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2136644. [PMID: 34985520 PMCID: PMC8733831 DOI: 10.1001/jamanetworkopen.2021.36644] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE Transient ischemic attack (TIA) often indicates a high risk of subsequent cerebral ischemic events. Timely preventive measures improve the outcome. OBJECTIVE To estimate and compare the risk of subsequent ischemic stroke among patients with TIA or minor ischemic stroke (mIS) by care setting. DATA SOURCES MEDLINE, Web of Science, Scopus, Embase, International Clinical Trials Registry Platform, ClinicalTrials.gov, Trip Medical Database, CINAHL, and all Evidence-Based Medicine review series were searched from the inception of each database until October 1, 2020. STUDY SELECTION Studies evaluating the occurrence of ischemic stroke after TIA or mIS were included. Cohorts without data on evaluation time for reporting subsequent stroke, with retrospective diagnosis of the index event after stroke occurrence, and with a report of outcomes that were not limited to patients with TIA or mIS were excluded. Two authors independently screened the titles and abstracts and provided the list of candidate studies for full-text review; discrepancies and disagreements in all steps of the review were addressed by input from a third reviewer. DATA EXTRACTION AND SYNTHESIS The study was prepared and reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses, Meta-analysis of Observational Studies in Epidemiology, Methodological Expectations of Cochrane Intervention Reviews, and Enhancing the Quality and Transparency of Health Research guidelines. The Risk of Bias in Nonrandomized Studies-of Exposures (ROBINS-E) tool was used for critical appraisal of cohorts, and funnel plots, Begg-Mazumdar rank correlation, Kendall τ2, and the Egger bias test were used for evaluating the publication bias. All meta-analyses were conducted under random-effects models. MAIN OUTCOMES AND MEASURES Risk of subsequent ischemic stroke among patients with TIA or mIS who received care at rapid-access TIA or neurology clinics, inpatient units, emergency departments (EDs), and unspecified or multiple settings within 4 evaluation intervals (ie, 2, 7, 30, and 90 days). RESULTS The analysis included 226 683 patients from 71 articles recruited between 1981 and 2018; 5636 patients received care at TIA clinics (mean [SD] age, 65.7 [3.9] years; 2291 of 4513 [50.8%] men), 130 139 as inpatients (mean [SD] age, 78.3 [4.0] years; 49 458 of 128 745 [38.4%] men), 3605 at EDs (mean [SD] age, 68.9 [3.9] years; 1596 of 3046 [52.4%] men), and 87 303 patients received care in an unspecified setting (mean [SD] age, 70.8 [3.8] years, 43 495 of 87 303 [49.8%] men). Among the patients who were treated at a TIA clinic, the risk of subsequent stroke following a TIA or mIS was 0.3% (95% CI, 0.0%-1.2%) within 2 days, 1.0% (95% CI, 0.3%-2.0%) within 7 days, 1.3% (95% CI, 0.4%-2.6%) within 30 days, and 2.1% (95% CI, 1.4%-2.8%) within 90 days. Among the patients who were treated as inpatients, the risk of subsequent stroke was to 0.5% (95% CI, 0.1%-1.1%) within 2 days, 1.2% (95% CI, 0.4%-2.2%) within 7 days, 1.6% (95% CI, 0.6%-3.1%) within 30 days, and 2.8% (95% CI, 2.1%-3.5%) within 90 days. The risk of stroke among patients treated at TIA clinics was not significantly different from those hospitalized. Compared with the inpatient cohort, TIA clinic patients were younger and had had lower ABCD2 (age, blood pressure, clinical features, duration of TIA, diabetes) scores (inpatients with ABCD2 score >3, 1101 of 1806 [61.0%]; TIA clinic patients with ABCD2 score >3, 1933 of 3703 [52.2%]). CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, the risk of subsequent stroke among patients who were evaluated in a TIA clinic was not higher than those hospitalized. Patients who received treatment in EDs without further follow-up had a higher risk of subsequent stroke. These findings suggest that TIA clinics can be an effective component of the TIA care component pathway.
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Affiliation(s)
- Shima Shahjouei
- Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania
| | - Jiang Li
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, Pennsylvania
| | - Eric Koza
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Vida Abedi
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, Pennsylvania
- Biocomplexity Institute, Virginia Tech, Blacksburg, Virginia
| | - Alireza Vafaei Sadr
- Department de Physique Theorique and Center for Astroparticle Physics, University Geneva, Geneva, Switzerland
| | - Qiushi Chen
- Department of Industrial and Manufacturing Engineering, Pennsylvania State University, University Park
| | - Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles
| | - Paul Griffin
- Department of Industrial and Manufacturing Engineering, Pennsylvania State University, University Park
| | - Annemarei Ranta
- Department of Neurology, Wellington Hospital, Wellington, New Zealand
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Ramin Zand
- Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania
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27
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Wang Y, Meng X, Wang A, Xie X, Pan Y, Johnston SC, Li H, Bath PM, Dong Q, Xu A, Jing J, Lin J, Niu S, Wang Y, Zhao X, Li Z, Jiang Y, Li W, Liu L, Xu J, Chang L, Wang L, Zhuang X, Zhao J, Feng Y, Man H, Li G, Wang B. Ticagrelor versus Clopidogrel in CYP2C19 Loss-of-Function Carriers with Stroke or TIA. N Engl J Med 2021; 385:2520-2530. [PMID: 34708996 DOI: 10.1056/nejmoa2111749] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Comparisons between ticagrelor and clopidogrel for the secondary prevention of stroke in CYP2C19 loss-of-function carriers have not been extensively performed. METHODS We conducted a randomized, double-blind, placebo-controlled trial at 202 centers in China involving patients with a minor ischemic stroke or transient ischemic attack (TIA) who carried CYP2C19 loss-of-function alleles. Patients were assigned within 24 hours after symptom onset, in a 1:1 ratio, to receive ticagrelor (180 mg on day 1 followed by 90 mg twice daily on days 2 through 90) and placebo clopidogrel or to receive clopidogrel (300 mg on day 1 followed by 75 mg once daily on days 2 through 90) and placebo ticagrelor; both groups received aspirin for 21 days. The primary efficacy outcome was new stroke, and the primary safety outcome was severe or moderate bleeding, both within 90 days. RESULTS A total of 11,255 patients were screened and 6412 patients were enrolled, with 3205 assigned to the ticagrelor group and 3207 to the clopidogrel group. The median age of the patients was 64.8 years, and 33.8% were women; 98.0% belonged to the Han Chinese ethnic group. Stroke occurred within 90 days in 191 patients (6.0%) in the ticagrelor group and 243 patients (7.6%) in the clopidogrel group (hazard ratio, 0.77; 95% confidence interval, 0.64 to 0.94; P = 0.008). Secondary outcomes were generally in the same direction as the primary outcome. Severe or moderate bleeding occurred in 9 patients (0.3%) in the ticagrelor group and in 11 patients (0.3%) in the clopidogrel group; any bleeding occurred in 170 patients (5.3%) and 80 patients (2.5%), respectively. CONCLUSIONS Among Chinese patients with minor ischemic stroke or TIA who were carriers of CYP2C19 loss-of-function alleles, the risk of stroke at 90 days was modestly lower with ticagrelor than with clopidogrel. The risk of severe or moderate bleeding did not differ between the two treatment groups, but ticagrelor was associated with more total bleeding events than clopidogrel. (Funded by the Ministry of Science and Technology of the People's Republic of China and others; CHANCE-2 ClinicalTrials.gov number, NCT04078737.).
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Affiliation(s)
- Yongjun Wang
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Xia Meng
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Anxin Wang
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Xuewei Xie
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Yuesong Pan
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - S Claiborne Johnston
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Hao Li
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Philip M Bath
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Qiang Dong
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Anding Xu
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Jing Jing
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Jinxi Lin
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Siying Niu
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Yilong Wang
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Xingquan Zhao
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Zixiao Li
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Yong Jiang
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Wei Li
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Liping Liu
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Jie Xu
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Liguo Chang
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Lihua Wang
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Xianbo Zhuang
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Jinguo Zhao
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Yefang Feng
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Honghao Man
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Guozhong Li
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
| | - Baojun Wang
- From the China National Clinical Research Center for Neurological Diseases (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), the Department of Neurology (Yongjun Wang, X.M., A.W., X.X., Y.P., H.L., J.J., J.L., S.N., Yilong Wang, X. Zhao, Z.L., Y.J., W.L., L.L., J.X.), and the Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), Beijing, the Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai (Q.D.), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), the Department of Neurology, Third People's Hospital of Liaocheng (L.C.), and the Department of Neurology, Liaocheng People's Hospital (X. Zhuang), Liaocheng, the Department of Neurology, Second Affiliated Hospital of Harbin Medical University (L.W.), and the Department of Neurology, First Affiliated Hospital of Harbin Medical University (G.L.), Harbin, the Department of Neurology, Weihai Wendeng District People's Hospital (J.Z.), and the Department of Neurology, Weihai Central Hospital (H.M.), Weihai, the Department of Neurology, Second People's Hospital of Huludao, Huludao (Y.F.), and the Department of Neurology, Baotou Central Hospital, Baotou (B.W.) - all in China; Dell Medical School, University of Texas at Austin, Austin (S.C.J.); and the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.)
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Elkind MSV, Hankey GJ. Advances in Epidemiology, Outcomes, and Population Science. Stroke 2021; 52:4057-4059. [PMID: 34702066 DOI: 10.1161/strokeaha.121.033973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mitchell S V Elkind
- Division of Neurology Clinical Outcomes Research and Population Sciences (NeuroCORPS) (M.S.V.E.)
| | - Graeme J Hankey
- Department of Neurology, Sir Charles Gairdner Hospital, Perth, Australia (G.J.H.).,Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia (G.J.H.)
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Tan Z, Zhao Y, Yang W, He S, Ding Y, Xu A. Efficacy and Safety of Adherence to dl-3-n-Butylphthalide Treatment in Patients With Non-disabling Minor Stroke and TIA-Analysis From a Nationwide, Multicenter Registry. Front Neurol 2021; 12:720664. [PMID: 34630292 PMCID: PMC8492907 DOI: 10.3389/fneur.2021.720664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/26/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Dl-3-n-Butylphthalide (NBP) has the potential to improve clinical outcomes in acute ischemic stroke patients by improving collateral circulation. We aimed to evaluate the efficacy and safety of NBP in patients with non-disabling minor ischemic stroke and transient ischemic attack (TIA). Methods: The BRIDGE (the observation study on clinical effectiveness of NBP on patients with non-disabling ischemic cerebrovascular disease) is a prospective registry to monitor the efficacy and safety of NBP therapy in acute non-disabling ischemic stroke or high-risk TIA. Non-disabling minor ischemic stroke patients within 48 h were enrolled across 51 stroke centers in China. We divided patients into NBP compliance or non-compliance groups according to their adherence to NBP. The primary outcome was the favorable functional outcome at 90 days, defined as a modified Rankin scale (mRS) <2. Results: Between 10th October 2016 and 25th June 2019, 3,118 patients were included in this analysis. In multivariable analysis, after adjusting for common risk factors and demographic factors, NBP-compliance group has a higher proportion of favorable functional outcome (92.1 vs. 87.4%, adjusted odds ratio 2.00, 95% confidence interval, 1.50–2.65), and a higher stroke recurrence rate (2.40 vs. 0.31%, adjusted odds ratio 8.86, 95% confidence interval, 3.37–23.30) than the NBP-non-compliance group. There was no significant difference in death and intracranial hemorrhage rate between the two groups. In subgroup analysis, patients with National Institutes of Health Stroke Scale (NIHSS) scores from 3 to 5 who complied to NBP therapy had a higher rate of favorable functional outcomes than the NBP-non-compliance group. [88.82 vs. 76.21%, adjusted odds ratio 2.52 (1.81–3.50), adjusted interaction P = 0.00]. Conclusion: In non-disabling minor ischemic stroke or TIA patients, compliance with NBP therapy led to better 90-day functional outcomes despite a higher risk of recurrence, and this effect seems to be stronger in patients with NIHSS scores of 3–5. Further large randomized, double-blind controlled studies to analyse the association between NBP and functional outcome is warranted in the coming future.
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Affiliation(s)
- Zefeng Tan
- Department of Neurology, the First Affiliated Hospital, Jinan University, Guangzhou, China.,Department of Neurology, Shun De Hospital of Jinan University, Guangzhou, China
| | - Yin Zhao
- Department of Neurology, the First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Wanyong Yang
- Department of Neurology, the First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Shenwen He
- Department of Neurology, Shun De Hospital of Jinan University, Guangzhou, China
| | - Yan Ding
- Department of Neurology, the First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Anding Xu
- Department of Neurology, the First Affiliated Hospital, Jinan University, Guangzhou, China
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A Novel Clinical Nomogram to Predict Transient Symptomatic Associated with Infarction: The ABCD3-SLOPE Score. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5597155. [PMID: 33937400 PMCID: PMC8062161 DOI: 10.1155/2021/5597155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/16/2021] [Accepted: 04/01/2021] [Indexed: 11/17/2022]
Abstract
Background It is hard to differentiate transient symptoms associated with infarction (TSI) from transient ischemic stroke (TIA) without MRI in the early onset. However, they have distinct clinical outcomes and respond differently to therapeutics. Therefore, we aimed to develop a risk prediction model based on the clinical features to identify TSI. Methods We enrolled 230 consecutive patients with transient neurologic deficit in the Department of Neurology, Tongji University Affiliated Tenth People's Hospital from March 2014 to October 2019. All the patients were assigned into TIA group (DWI-negative) or TSI group (DWI-positive) based on MRI conducted within five days of onset. We summarized the clinical characteristics of TSI by univariate and multivariate analyses. And then, we developed and validated a nomogram to identify TSI by the logistic regression equation. Results Of the 230 patients, 41.3% were diagnosed with TSI. According to the multivariate analysis, four independent risk factors, including smoking history, low-density lipoprotein cholesterol, brain natriuretic peptide precursor, and ABCD3 score, were incorporated into a nomogram. We developed a predictive model named ABCD3-SLOPE. The calibration curve showed good agreement between nomogram prediction and observation. The concordance index (C-index) of the nomogram for TSI prediction was 0.77 (95% confidence interval, 0.70-0.83), and it was well-calibrated. Conclusions Smoking history, low-density lipoprotein cholesterol, brain natriuretic peptide precursor, and ABCD3 score were reliable risk factors for TSI. ABCD3-SLOPE was a potential tool to quantify the likelihood of TSI.
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Schlaganfall: TIA erhöht Risiko. Dtsch Med Wochenschr 2020. [DOI: 10.1055/a-1252-3792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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