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

Hoshino, T. et al. (2019) Non-cardioembolic stroke/transient ischaemic attack in Asians and non-Asians: A post-hoc analysis of the PERFORM study. European Stroke Journal, 4(1), pp. 65-74. (doi: 10.1177/2396987318797245) (PMID:31165096) (PMCID:PMC6533862)

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Introduction: We aimed to compare the characteristics and vascular outcomes between Asian and non-Asian patients with non-cardioembolic stroke/transient ischaemic attack receiving antiplatelet monotherapy and to identify population-specific predictors for recurrent events. Patients and methods: We conducted a post-hoc analysis of data from the PERFORM study, in which 19,100 patients (mean age, 67.2 years; male, 63%; 2178 Asian and 16,922 non-Asian patients) with non-cardioembolic ischaemic stroke/transient ischaemic attack were randomised to aspirin or terutroban and followed for two years. The primary outcome was a composite of major adverse cardiovascular events (non-fatal myocardial infarction, non-fatal stroke and cardiovascular death). Results: There was no difference in major adverse cardiovascular events risk between Asian and non-Asian populations (11.1% vs. 10.5%; p = 0.39). However, Asian patients were at significantly higher risk of intracranial haemorrhage (2.4% vs. 1.3%; hazard ratio (HR) 1.87; 95% confidence interval (CI) 1.34–2.60; p < 0.001) and major bleeding (5.4% vs. 4.1%; HR 1.30; 95% CI 1.04–1.61; p = 0.02). Stroke risk was significantly higher in Asian than in non-Asian populations among patients with lacunar stroke (7.4% vs. 4.5%; p = 0.02). In multivariable analysis, diastolic blood pressure (HR per 5 mm Hg 1.08; 95% CI 1.01–1.16; p = 0.03) and diabetes (HR 1.36; 95% CI 1.22–1.52; p < 0.001) were independent predictors of major adverse cardiovascular events for Asian and non-Asian patients, respectively. Conclusion: Compared with non-Asian patients, Asian patients had significantly higher risk of haemorrhagic events when given antiplatelet monotherapy for secondary prevention after non-cardioembolic stroke/transient ischaemic attack. Lacunar stroke and elevated diastolic blood pressure were more associated with recurrence risk in Asian patients.

Item Type:Articles
Additional Information:The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: TH reports research grants from AstraZeneca and SOS-ATTAQUE CEREBRALE Association. KMF reports honoraria from Servier (lectures). PGS reports research grants from Sanofi and Servier (steering committee chair) and honoraria from AstraZeneca, Bayer, BoehringerIngelheim, Bristol-Myers Squibb, CSL-Behring, DaiichiSankyo, GSK, Janssen, Lilly, Novartis, Pfizer, Regeneron, Roche, Sanofi, Servier, The Medicines Company, Amarin (steering committee), and Pfizer (event adjudication committee). PA reports research grants from Pfizer (TST trial), Sanofi, and AstraZeneca (, research support from AstraZeneca (SOCRATES), GSK (SUMMIT adjudication committee), Fibrogen (Roxadustat DSMB), and Pfizer (SPIRE executive committee), and honoraria form Pfizer, Sanofi, and Bayer (speaking activities). The PERFORM study was funded by Servier, Suresnes, France. Jenny Lloyd (MedLink Healthcare Communications Limited), who edited the manuscript for non-intellectual content, was funded by SOS-ATTAQUE CEREBRALE Association.
Glasgow Author(s) Enlighten ID:Ford, Professor Ian
Authors: Hoshino, T., Sissani, L., Labreuche, J., Bousser, M.-G., Chamorro, A., Fisher, M., Ford, I., Fox, K. M., Hennerici, M. G., Mattle, H. P., Rothwell, P. M., Gabriel Steg, P., Vicaut, E., and Amarenco, P.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
Journal Name:European Stroke Journal
Publisher:SAGE Publications
ISSN (Online):2396-9881
Published Online:24 August 2018
Copyright Holders:Copyright © 2018 European Stroke Organisation
First Published:First published in European Stroke Journal 4(1):65-74
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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